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Monday, January 8, 2007

VA Gilgamesh Cartoon Insults VA Doctors

I actually need to say that the cartoon version of the Gilgamesh story is aimed at VA doctors, and if I were them I would be insulted. Most of the doctors and nurses I have met at the VA in recent years have been polite, concerned and helpful, nothing like the cartoon of Doctor U. or the way it was for Vietnam Vets in the 60's and 70's.
What angers me is that someone was paid to make this insulting information-free, misinformed (the paralysis before combat...what is that? Are they trying to mention conversion reactions when someone in the field for the duration would become paralyzed??? or blind??? in both World Wars???). And Gilgamesh is dirty and unshaven which proves he has PTSD??? NOT! Most people with PTSD are working a job and killing themselves to look FINE... (although I know at some VA compensation exams if you don't show up dirty and unshaved, you will be denied, that is the compensations system, not the treatment people).
How much did it cost?
Who approved it?
Who made it?
Let them all lose their jobs, and use the money for information which will actually help the doctors do a better job, or inform the patients about PTSD. This cartoon does neither.

A waste of money
This is probably the stupidest waste of VA money I have seen in a long time. If you take the time to watch it, you will be amazed by the self-centered, self-absorbed doctor, the incredibly stupid jokes, the lame attempts to be reassuring, the absolute lack of empathy. I mean it is pathetic.
Actually it may also be accurate. There's a frightening thought.
I followed some of the links at the end.
The scariest was on
"Intensive, three-week, multi-disciplinary treatment program for patients with deployment-related stress, Post Traumatic Stress Disorder (PTSD) and/or difficulties adjusting to re-deployment" [my italics] So they are sending people with PTSD BACK, which is completely unethical. It is well known from Israeli studies that combat vets with PTSD in one war or deployment get it worse in the next one.
Another frightening line towards the bottom of the description of what sounds like it might be a worthwhile program if it weren't used to send people with PTSD back, is "The individual's command must approve program attendance." So the numb ("It didn't affect me") or clueless (no combat experience) CO has to approve a medical decision, instead of the medical staff. Do CO's approve all other medical decisions? Are CO's the new insurance company representatives in the military structure?
Anyone who has studied the Vietnam War, or any other war, as I have, knows there are always officers who will sacrifice their own men so they look good. They should not be in the position to do this to men and women with PTSD.

Sunday, January 7, 2007

Heart attacks and PTSD

Study: War Trauma May Raise Heart Risks

Associated Press Writer
I have no idea how to make that a link.
This is a really good study and about _______ time.
A few years ago, a famous psychiatrist [George Valliant, MD. I remembered!] whose name escapes me at the moment (Halfheimers, when you don't quite have altzheimers, or is it CRS... can't remember) did a study of all the WWII vets who had gone to Harvard. They had thorough medical histories of them when they got into Harvard, so they looked for PTSD in those who had seen combat. He, of course didn't find much (Ha ha. The old school) but he did find that by age 65 most of the WWII Harvard combat vets were either physically very ill or DEAD, which was incredible!
There have been other studies connecting PTSD with stress related diseases.
One of the earliest descriptions of PTSD, in Civil War veterans, was published in 1876. Dr. Da Costa described a set of heart symptoms and called them Soldier's Heart. My husband had this when he came back from Vietnam, but since it was old medicine, no one had ever heard of it, and they told him he could probably die of it anytime. Wonderful for a person diagnosed with "nervousness" since there was no diagnosis of PTSD at that time.
And when he had his last C&P exam a couple of years ago the young woman doctor didn't KNOW that no one was diagnosed with PTSD in 1968 because the Diagnostic and Statistical Manual II of the American Psychiatric Association had no such diagnosis. As a matter of fact, they had just discarded the "Gross Stress Reaction" of the first edition and decided, on no scientific evidence whatsoever, that if a trauma affected you for more than 6 months, you were screwed up before the trauma...
How could a person like that be doing compensation exams for the VA? Of course she was better than Umesh Mahtre, MD, who asked my husband how he was doing. Bob said "about the same." They talked about flying for a few minutes. We thought he was trying to put Bob at ease, but that was the end of the interview and his report was, "The patient reports no problems." He was famous among the local veterans for never seeing PTSD even when it was in his face.(If this has happened to you, the exam is "inadequate for compensation purposes" and you can immediately in writing ask for another exam on that basis.)
The VA compensation system (which is different from and separate from and, as far as I can see, IGNORES the doctors at the VA Hospitals and other treatment facilities) in many areas of the country does it's best to see that those who need help die before they get it, some of the deaths no doubt brought on by stress related heart attacks.
If you want to help, write your representative and senator and ask for more funding for treatment at the VA, and for forced retirement of any old hack in the VA Compensation system who routinely denies PTSD claims or denies them with insane criteria such as this one, which a friend of mine received: "Since you were an infantryman and seeing the death of a friend in combat is not outside the range of usual human experience for an infantryman, you do not have a traumatic stressor." Totally wrong, but he still may have his job...

Saturday, January 6, 2007


I subscribe to the Psychotherapy Networker e-newsleter and just read a great article by Nancy Errebo, Psy. D. about using EMDR with a returning vet. (This issue has 3 articles on PTSD.)
Two quotes struck me:
"while nightmares and flashbacks are very troublesome and painful, avoidance is by far the most dangerous aspect of PTSD-in fact, it maintains the fear and vigilance and the constant preoccupation with the war. "Avoidance also becomes a way of life," I said and described some veterans I know who'd spent many years avoiding almost everything and everybody in their largely unsuccessful attempts to stay calm. There's no healing without exposure to the memory and the emotions that go with it, I added." [my italics-Patience]
and also:
"the brain naturally tries to process trauma by reviewing experience, but the images and emotions are so vivid that nightmares and flashbacks result. So the opposite, also completely natural, tendency kicks in and the brain tries to avoid the pain by numbing the emotions. At this point, the information can't be processed, and the cycle just repeats over and over again-the natural healing process getting caught in a kind of gridlock. EMDR is designed to break the gridlock and keep the information processing system active so that healing can occur."
This article also mentions EFT, Emotionally Focused Therapy for couples, one of the therapies I think is stupendous. Dr. Errebo wrote an article on that: "EMDR and Emotionally Focused Couple Therapy for War Veteran Couples" in the Handbook of EMDR and Family Therapy Processes. I belong to the International Society for Traumatic Stress Studies, and often go to their conferences. I saw Susan Johnson, the developer of EFT, give a workshop on it, and it was simply wonderful.
A lot of VA's do offer EMDR these days, and it works for many people. Processing the trauma may only be the beginning of recovery, however, if you grew up in a home where there was a war between men and women. EFT offers the chance to make your home a sanctuary instead of a battleground. So does applying the principles of Al-anon to life with PTSD and I'm sure there are other effective therapies, but this is the one that I know about.
Another therapy that I attended a workshop on is ACT, Acceptance and Commitment Therapy. I felt that this was another one that I would like to see in every VA. If you Google "Steven C. Hayes" and "Sonja V. Batten" and "Acceptance and Commitment Therapy" you can find out more from the people who developed the concept. I think it pays to be an informed consumer of mental health and to speak up for what you feel would help you.
By the way, none of the devlopers of these therapies think their way is the only way. When a therapist tells you that their therapy should have worked, that's when instead of feeling like a failure, you need to find a new therapist. The failure is not you. It's different if they say "this doesn't seem to have helped you, so lets try and find something that will, perhaps with another therapist." That is honest, because people are best with techniques they know and love, as long as they don't imply that you failed.
Actually, I think I have to qualify that,too. If you try to do therapy while drunk, stoned, in a food coma, etc (all of which may be the PTSD symptom: efforts to avoid thoughts or feelings associated with the trauma) you can prevent your own healing. It is like the healing of any wound. Pain is involved. You went through hell and healing it will hurt. So you heal in small doses with help. But if you don't feel, you won't heal.
I often say it is good to be able to go in and out of the numbing at will, since the numbing is a survivor skill. But healing is something else, something beyond numbing. When you numb pain, you also numb joy...
And if your pain is intolerable, there are programs like Dialectical Behavioral Therapy, which teach you skills in tolerating painful emotions before you try to do trauma work. I don't know of a VA where they do that either, but I hope it will come.