Saturday, September 27, 2014

PTSD Abuse: Belief & Morality!

PTSD is abused not just in compensation claims but as a mental condition to avoid say murder trials.                                                                                                                                               

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.

It seems to be against common sense to suggest that talking may not be good for severe traumatic experiences. This is more so for someone brought up on psychoanalysis; yet, the evidence is clearly against talking especially in severe trauma.
In 
The Cockroach Catcher:
The speaker was a Senior Registrar from the Maudsley.

"......He was a Registrar at the time of the King’s Cross fire. He was just coming out of the station when the accident happened, and so was at the front line so to speak not just as a pedestrian but also as a psychiatrist. He became interested in PTSD (Post Traumatic Stress Disorder) and did a fair bit of research on King’s Cross and other disasters.

He quoted a number of cases, including the Herald of Free Enterprise disaster. There were those who despite help of all kinds would commit suicide. Many were heroes in that they saved many lives. Yet the feeling that they did not deserve to live eventually overtook them and they committed suicide.

What was most surprising was how the group that had counselling generally faired worse, much worse than those without any counselling. The group that did best were the ones that drank, and drank a fair amount.

It was not his intention to promote vodka but he thought we could not be kept from the truth……

His research showed that talking about the incident seemed to make things worse, much worse than anyone ever imagined……”
Then he remembered 
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.”
Kim Phuc never had any therapy.

We have to be aware that a whole industry has sprung up based on very inexact theories and it is nice to know that the earlier findings in England have now been 
confirmed across the pondIn cases where mental conditions are entangled with compensation claims it becomes especially difficult to be truly objective.

On the matter of psychotherapy, a good deal of current blog comments are hostile to therapists and their methods. A good therapist is hard to come by, and should be like a wise aunt or uncle to whom one turns to for advice that one may or may not accept or act on. A good therapist needs to be intelligent and broad-minded, and mature with rich life experience. A bad therapist, on the other hand, takes over and does not allow for any leeway on how one should continue with life.

We may forget too that good therapy is for life, and may be more useful for the mentally healthy than for the mentally sick. What government or insurer would allow for that?

Here I will have to quote my Guru again:

“A Therapist is like a toilet really: some may need it three or five times a week; others once in a while. Some patients may have a sort of mental diarrhoea and require therapy sessions more often.”

My only gripe is that where money is involved, one needs to be cautious: the best advice in life is free, like those from your wise aunt or uncle, if you are lucky enough to have one.


Part II:

Then came September 11. I remembered I was on holiday in Spain when it happened. I had just finished golf. I put my clubs away and went to the club house for a drink with my playing partners. As I approached their table, I sensed that something was wrong. There were no drinks.
         Then one of them said, “One of the World Trade Center Towers is down!”
         I was trying to see if I heard right.
         “In New York?”
         “New York.”
         Then moments later, the Spanish waitress came out and said to us, the second tower was down too.
         I rushed back to our villa and shouted to my wife to turn on CNN and tried to contact our children, one of whom worked in Manhattan.
         Lines were dead.
         Luckily, an Email came through our other daughter who was in England: Sis OK, at a meeting on 55th Street. Now trying to walk home to Brooklyn.
         What a shock.  Unlike my parents’ generation we have had a long period of peace and prosperity but now everything was shattered.
         The following day my office put a call through and I talked to my Associate Specialist.
         The clinic just had an urgent referral. A local girl was referred. Very disturbed by what happened as one of her father’s good friends was one of the pilots whose plane went down. The family spent many holidays with them in their Florida home and she was now most upset.
         “Whatever you do, by all means talk to the parents but not to the girl. No one should see her. They should not turn on the TV and avoid any reminder of what happened.”
         I then nearly said, “Give her Vodka, Gin or similar,” but I did not.
         I gave the next best thing.
         “Put her on a short course of Benzodiazepine to let her sleep for a few days.”
         It shocked my Associate Specialist. It was not a drug I normally used, if at all, and why now?
         Well, whatever happened, all I could say was that the family was in total agreement and months later my Associate Specialist told me that it was brave of me but it seemed to have worked for this girl.
        
        
         In July last year I met a young couple at the swimming pool of our holiday condo. I thought they were Chinese but it turned out they were Vietnamese Chinese.
         We started chatting. He said he left Nam (Vietnam) on the last day.
         Jokingly, I said, you mean you were on the Helicopter?
         “Yeah, how did you know?”
         “You looked too young to be working for the Embassy.”
         “My mum worked there. But my story was nothing, you should hear hers.”
         His wife, an elegant looking petite Chinese swam closer.
         “So, tell me.”
         Well, she came out later. Her mother put her and four sisters on a junk (a Chinese fishing boat), one of those that took refugees out of Nam for an exorbitant fee and generally it had to be gold. Their boat sank outside Hong Kong but they swam ashore. She spent the next three years in one of the Hong Kong camps.
         “Yes, I remember those.”
         “I know - the stench. We got used to it.”
         Those camps were run under the auspices of the United Nations but the UN never really paid Hong Kong a single dollar. However that is beside the point. Conditions were very poor and one could hardly decide if it was Hong Kong’s or UN’s fault. Every time we drove past it was like passing a local authority rubbish tip. We had to wind up the windows. Yet there were politicians who felt they needed to keep it bad to deter people. They continued to flow in right up to the handover. As it was still under British rule, Britain tried its best to keep people from going to Britain. They needed not have worried. Most wanted to go to U.S. An irony really.
         I said something that sounded like an apology, an apology for Hong Kong, and for mankind.
         “No. It’s fine. I am not bitter. We waited and we got to the U.S. There was nothing you could have done anyway.”
         She told me someone suggested that she should have some therapy. She never did.
         “Some things you can never change. If it happened it happened.”
         But she managed to get most of her family out of camps and settled in the US. She was very successful in her business and her only regret was that her parents never made it.
        
         What a story of human resilience and triumph over adversities.
         And I can still remember that lunch time meeting and the learning from King’s Cross.

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 byB.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


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