Thursday, October 27, 2011

PTSD: Science Or 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.

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,” 

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


Myalgic Muslimah said...

Hi there,

Your post on PTSD caught my attention and was a very interesting read. The idea of people making up psychiatric symptoms for compensation is something I've heard of before. There was a post on a forum a couple of months back from a woman asking for advice.

Her neighbour was going to the Dr claiming that her son (who was about 3 years old) was autistic, exhibiting violent behaviour, not understanding social cues etc (seemed like she read the symptoms on a website and reeled them off). So the woman on the forum was seeking advice because she'd interacted with the child many times and could find no such symptoms. He behaved like a perfectly normal child and didn't even have a temper as the mother alleged to the Dr and she believed the mother was lying in order to claim disability benefits but as she was friends with the mother, she felt reluctant to 'rat' her out.

I thought it was a one off case but your post would suggest it's more common than I thought. I advised the woman to report her neighbour to the DWP for the safety of the child, because a normal child being placed in a special needs school and on unnecessary medication is child abuse and how much further will this woman be willing to go to 'prove' his behaviour? Harm herself and claim the child did it? Claim the child is lying if he starts to say things are different from what she's claiming? If anything, it sounds like the mother would put her and her son on a disturbing journey towards MSBP.

Another thing I find very disturbing as someone who suffers from a chronic physical illness, is that I'm concerned about the tightening of definitions (however well intentioned) could lead towards genuine sufferers being turned away or disbelieved or mistreated as fraudsters. I've seen it happen SO MANY times when it's come to very severely ill housebound and bed bound people being told to attend 1st and 2nd floor interviews without the aid of a lift and having reports stating that the patient can walk fifty yards when the patient cannot walk 50cm.

It's a difficult and very delicate balance. I don't want people to jump on the bandwagon of suspecting all claimants to be fraudsters, although of course the fraudsters do need to be weeded out. There's enough bad press as it is about getting ESA claimants back into work and treating claimants like layabout scum. It's degrading.


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