Sunday, July 8, 2012

PTSD & Compensation: Belief & Morality!

Do you believe in PTSD?

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.

I always show my juniors the photo of Kim Phuc:

“By rights possibly one of the most damaged psychologically and physically. She underwent no fewer than seventeen operations. The photo of her running down the street of Saigon naked probably changed the course of the Vietnam War and the world’s perception of good and bad. Then came her dramatic escape in 1992 to Newfoundland and her eventual settling down in Canada. Human resilience is not to be underestimated and the imposition of psychological intervention could represent a great under-estimation of our genetical endowment. At one of her public lectures, one of the war veterans who was a helicopter gunner broke down.”

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 psychiatry depend on belief?
I was drawn to a book review in the
Wall Street Journal : 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.

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,”

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


Can't think of a name said...

I suppose in this country the financial incentive might be a War Pension, but you'd have less hassle claiming ESA and you wouldn't have to show a cause for your mental distress. For DLA, you don't have to have a clinical diagnosis, you have to have care and/or mobility needs. It matters not one jot how they arose.

As for whether DLA exists, I think that the current criteria miss the point completely. I think that making the decision to kill a fellow human being or watching a fellow human being being killed changes you in a way that cannot be reversed. Never mind whether individuals have PTSD, whole communities and countries get an aftershock of war that can last for generations.

Cockroach Catcher said...

We are talking about the so called heroes that were never at the Vietnam War.

Can't think of a name said...

Sorry, I missed the point, I apologise.

Anti Money Laundering said...

Freedom, morality, and the human dignity of the individual consists precisely in this; that he does good not because he is forced to do so, but because he freely conceives it, wants it, and loves it.