Sunday, June 29, 2008

PTSD: Diagnosis du Jour

I was drawn to a book review in the Wall Street Journal this weekend: Five Best - Paul McHugh on books about the factions and follies of psychiatry. To me, that the WSJ should review five psychiatric books together is most unusual. One of the books reviewed was: Stolen Valor by B.G. Burkett and Glenna Whitley.

Stolen Valor looks into the diagnoses of Post Traumatic Stress Disorder (PTSD) in Vietnam Veterans, the real heroes and the faked victims. I was rather stunned.

I remember one of my juniors asking me if I believed PTSD existed.

What could I have said? It was new at the time and we just had a few major disasters and the Gulf War. O.K. We did not have Vietnam and The First and Second World Wars seemed a long, long time ago.

It so happened that a lawyer who was acting on behalf of one of my patients specifically asked about PTSD, and for good measure, she sent me all the available literature. All I knew then was psychiatric diagnosis and compensation often created a division, especially in the courts of law, and it all depended on whose side you took.

And why should science depend on belief?

The WSJ book review said:

Psychiatrists who tend to work on social agendas that are remote from patient care constitute the discipline's ‘political faction.’ Almost unfailingly, its politics support left-leaning government policy and can have a pernicious, blame-America-first effect at times of international crisis. In ‘Stolen Valor,’ B.G. Burkett and Glenna Whitley produced a classic indictment of this faction's overreaching.”

It followed:

“The authors describe how Post-Traumatic Stress Disorder (PTSD) emerged as a new diagnosis from the Vietnam War, the result of an alliance of antiwar psychiatrists, VA hospital administrators, and patients who never saw combat or even Vietnam service but found that reciting the PTSD symptoms would result in the awarding of disability payments.”

No mincing of words here.

“These allies combined to cultivate the idea that hundreds of thousands of Vietnam veterans were rendered incapable of normal civilian life because they had suffered an ‘incurable wound’ of the mind.”

An incurable wound? There are numerous examples of those who have "overcome"! What about the likes of Charlize Theron, whose alcoholic father was shot by her mother in front of her eyes at the tender age of 15? She rose to become an extremely successful actress and was awarded an Oscar for Best Actress in 2004.

Over a period of ten years, Mr. Burkett, using the Freedom of Information Act, found that some 1,700 individuals, including some of the most prominent examples of the Vietnam veteran as dysfunctional loser, had fabricated their war stories. Many had never even been in the services. Some even claimed they were in Vietnam long after the war ended. War did funny things, or was it money?

In my years of practice, I have seen many parents who want a diagnosis for their children that allows them to claim compensation. ADHD is one of the most notable one. The problem is that if we are not careful, children may be put on medication just so that their parents can claim Disability Benefit.

We psychiatrists have to be able to tell the fakes in our work so that the real patients get the care they deserve.

There is now a move to tighten the definition of PTSD in DSM V.

“Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other,” so said John Adams, second President of the United States of America. He died on July 4, 1826, aged 90 on the 50th anniversary of independence. He outlived Thomas Jefferson, the third President, who also died on Independence Day, by just a few hours.

President John Adams

The White House Website

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