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Tuesday, June 24, 2014

The reality of denial: Day 24 of National PTSD Awareness Month

Then there is the reality of denial. It is not just a river in Egypt. Denial is pervasive in veterans where it is protective, in families and in the professional community, where it causes secondary traumatization to people who have PTSD.
The funny thing is that the shrinks who denied PTSD from 1968-1980, (and some still do), were calling numb guys psychopaths because they could talk about horrible things with no emotion. Isn't that what psychiatrists do and call it professionalism?
Well, these guys are professional too, and numbness is required to do their job.
After 1980, when PTSD was forced into the Diagnostic and Statistical Manual despite the American Psychiatric Association's "it will cost too much money," many professionals thought it was a made up diagnosis for Vietnam vets and would not see it, despite the evidence in front of them. People see what they want to see.
There were studies on Vietnam Vets, some of which did not ask if the vet had even been in Vietnam or in combat, which conveniently found that 12 to 17% of vets were adversely affected. Hahaha! And guess what, the current crop of studies, run by the military and the VA, find similar percentages. One military shrink reporting on the unit he was in at an ISTSS meeting said he had to change the diagnostic criteria to get his percentage down to 17 from 28, and he did. NICE.
There has only been one completely observant study, the National Vietnam Veterans Readjustment Study, funded under Jimmy Carter and published under Ronald Reagan, who only allowed the Government Printing Office to print about 100 copies. In this study, which included talking to the veterans as well as standard diagnostic questionnaires, of the people who had been through the most war zone stress, combat, seeing a lot of wounded and dead, being shot at, etc, 66% of them had had diagnosable PTSD at one time, 33% still did. 

Guys, that means it is normal. And no one can say a vet didn't get PTSD till after he's dead. There is always delayed onset...
I also found studies of WWII combat vets and POW's who were receiving treatment at VA's for medical reasons. Over 50 % had had PTSD at one time and about 30 % still did, undiagnosed, lying there in a bed in the VA!
WWII vets were not too modest to talk about it. They didn't talk about it because they couldn't. They had a good GI Bill and a good economy, too, so many of them dealt with their PTSD through workaholism and were considered "resilient," my least favorite word since it is code for workaholism, something doctors aren't likely to notice...
Acceptance of PTSD comes and goes in waves. WWI yes. In between, no. At the start of WWII they thought there wouldn't be any. When there was, they ascribed it to not getting along with your mom (I kid you not) and many other similar blame the survivor phrases until almost the end of the war. Then some people got help. Some of the help was pretty bad. They did lobotomies!
In 1965 Drs. Archibald and Tuddenham published an article on WWII combat vets who were still having nightmares, startle responses, etc. It was totally ignored.
I mentioned "Gross Stress Reaction" the term for PTSD in the first Diagnostic and Statistical Manual of the American Psychiatric Association, which was apparently based on observation and not theory. DSM II came out in 1968, actually in the bookstores during the Tet Offensive (so ironic), and on the basis of NOTHING, dropped GSR and substituted "Transitional Situational Disturbance." This is what I call the APA's denial and delusion period. Eventually, sanity prevailed and PTSD became the name of the diagnosis. There was actually quite a lot of good help there for a while. The Vet Centers were founded where you could get help without hassles.
At the VA's it was more like help with hassles, but it wasn't the PTSD staff that hassled, it was usually the VA Compensation Crooks.
Oh, did I say that? The people who delay and want more info and then give you 10% if you are 50% disabled and 50% if you are completely and totally unable to work but forgot and shaved before you came into be evaluated. I think I mentioned the young woman psychiatrist who told a veteran of Hamburger Hill that it "can't have been as bad as the movie." One of the guys in Recovering from the War was told in a letter from the St Pete Regional Office that since combat was not "Outside the range of human experience for an infantryman" that he did not have a traumatic stressor. This crap is still going on as I write.
Well, now I am too mad to write more, so more tomorrow.

1 comment:

  1. Sadly, not only do some VA lackeys deny the existence and impact of PTSD on combat soldiers, but mainstream medicine has their head in the sand as well. Nursing leadership in the civilian world is very hardcore about this, a majority believing that men with PTSD are "just as*holes" and regularly encourage their families to abandon them. I worked in the "medical arena" in an allied health position, and ran into this. What struck me the hardest is that I see so little compassion. I sit and shake my head, thinking, "Really?"