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Thursday, December 7, 2006

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.


  1. Patience, I was given your blog-site by a member of Pointman which is a Vet Biker Ministry which works with healing vets, decades after the war. I don't know where to begin. I relate with every word you say. My husband and I married in '65, he did Nam 67-68. I had no idea what our next 4 decades would be like. He was by Phu Bai & Hue and there during Tet. He is a poster boy for PTSD and we never even knew what was wrong. We moved 33 times, 7 times to 4 states .. always lived in isolated places, mtns. even on an Indian reservat- ion in Montana for 5 yrs. (We're from Michigan). He had a 'crisis' about 2 1/2 yrs ago at work, was given a book called Nam Vet, went to bed to read it and literally woke up crippled the next day! He couldn't use one leg, lower back or stand up straight, it took him over 6 wks, missed work, etc before he got over it! That was our wake-up call to PTSD.
    Now he's done 2 stays in Battle Creek trauma unit and 1 stay plus other visits to Chicago VA Trauma Unit. (he is now 100% disabled)When I visited his shrink the first time and found out that all we (I) had been through had a name and someone else knew about it I felt like I was going to explode, like if I let the lid off I would break down and never come out of it. I cried for 6 months (a first for me) then I was MAD for another 6 (I 'never' got mad)& I literally could not talk when with a psych, there just were no words. When I left N Chicago VA with my husband the last time I asked 'where I as a wife could go for help', and was told there was no provision for the wife or family. Especially in northern MI where we live. So I said I didn't know what I was going to do, but I WAS going to do SOMETHING when I got home. So I started to set around and wait out side while W was in his group meeting at a local (1hr drive) VA Clinic. I started trying to meet some of the ladies I saw coming and going and picking up their husbands. Soon I had a small group that began meeting out side in front of the VA bldg. When we began hauling chairs out of the waiting room, I asked if they had a room we could use and they have provided us with a small office or room almost every time! I use a PTSD list for wives (2ndary PTSD)and a book on Boundaries. It's been over a year now. We are having many inner healings and marriages healed, including my own!
    I tell the ladies I have the meetings because I'm the one who needs help the most and of course thats the truth! Usually the first time they are there they just set and cry all hour. It's just over- whelming the first time you realize you really are in a safe place among women who have been right where you have in so many ways. Well, I too could go on indefinately. But I'm better now. At times I still need to just go to my room and cry when I feel like it. My husband & I are both recovering and try to understand the mutual pain. I can only wonder how bad his must be, and what he went through, my pain is just from his trying to cope and stuff his trauma. We are going back to Chicago next weekend for their re- union party and we will both see the psyche. I hope I will be able to talk, I know alot of healing has taken place since the lid came off the can of worms. I will be reading your site, and out here somewhere gathering up wounded souls and doing what I can. Comment to me if you can.
    Finding my Voice,

  2. This comment has been removed by a blog administrator.

  3. I am just learning this blog stuff, and did not realize I could not edit other people's posts, so I apologize to Chris. I had to remove Chris' post since it had complete articles in it, which is not fair to the person who wrote them unless you get their permission. Please only post links to articles and the title, and maybe a sentence or two...
    GloryB please check out my website, There is a link at the top of the page. I have an article on Boundaries there which you can download and a free format for a 12 step meeting for Veterans Familise and Friends. There are other articles you would probably find helpful,too. Anything you can print out can be shared with anyone as long as you include my copyright and that it is reprinted with permission (which is right under the title on most of them. If not it is at the end.)

  4. Hello Patience,
    The conflict of interests pisses me off too. So does the misdiagnosis of personality disorder, just to avoid compensation to our wounded soldiers. The VA acts like it's some huge mystery that war causes ptsd, and changes people forever. The betrayal of what's right is a huge contributor to ptsd in my opinion too. (I wound up re experiencing the original trauma in therapy when reading Dr. Shay's book Odysseus in America)
      "Dishonor arouses the desire to kill-self or others, sometimes both. Honor and dishonor are social processes, which declares "the truth" of a person's or groups worth. People will kill for it, and will die for it." (Dr. Shay)
      The VA dishonors the truth of a veterans experiences by denying the reality of war.
    I get angry too when the military looks for something else to pin the ptsd on, like a troubled childhood. Okay, I will give you that young boys and girls trade one dysfunctional family (of origin) for another. (the military, don't talk, don't think, don't feel) War is traumatic, and no one leaves a war zone without at least a touch of ptsd.
    My question to you today is, is there a middle ground? I'm a child abuse survivor, and an adult child of an alcoholic. Now that my vet is aware of ptsd, he says he thinks I had it when I met him. I had my share of troubles as a youth believe me. I was numb to the warning signs too, and wound up re experiencing my youth over and over again with my vet. I have to say, I never felt like this before. Even though I had some of the symptoms, I don't know that I had full blown ptsd like this. After the incident in therapy, after the betrayal of what was right, that's when my heart was permanently affected. Now when I am stressed, I truly understand what my veteran experiences. My heart feels like it's going to burst inside the walls of my chest. The effects on my heart are the hardest to take. I've never experienced high blood pressure in my life, until now. The denial that families suffer in the aftermath of war did a lot of harm. Why is that I could have been affected by my past, yet never really had full blown "chronic" ptsd until I was traumatized in therapy?
    I think it's like that for our soldiers too? Not being perfect doesn't mean you suffer from ptsd. Overwhelming stress causes it I think?
    I'd love to hear your thoughts on this. Is there a middle ground, where you have some of the symptoms of ptsd, but it takes something huge (like war, or that betrayal of what's right) to push you completely over that edge?
    Thanks Patience. I love you. When I get really angry, it helps if I take deep breaths and use biofeedback and autogenic training to rid myself of the distressing thoughts. The anger is evidence that something needs to be changed. The dysfunctional military system who sends boys off to war, but doesn't want to acknowledge the damage they've done is on the top of my list of things to change. Any suggestions on how we can do that?

    VA faulted on mental health spending,13319,120089,00.html?wh=news

  5. Patience, I don't know if you subscribe to Military Times online or not but one of today's articals was about a study comissioned by the VA. They look into the connection between heart attacks and PTSD. They did a study starting in 1984 with WWII and Korean Vets. It showed a much higher risk for heart attacks for those who had PTSD,Combat Fatigue, or what ever you want to call it than those who served but showed no symptoms.

    BlueGhost Two-Zero

  6. Sometimes i feel as if I am going to have the heart attack and he is the one with PTSD. though he wont admit it since he is active duty.
    I feel so hurt and betrayed by him and the Army life etc. where it is unacceptable to even talk about war feelings and keep a job, that I feel like my pulse is racing, i cant eat and it is depressing.
    I think spouses suffer a great deal when living with PTSD, possibly they can even get sick themselves...