The current propaganda meme is that the combat damaged troops are trying to game the system to bilk the taxpayer out of hard earned cash. Military veterans who earned these benefits by virtue of their sacrifice and service to the nation are being Swiftboated by operatives of the government which uses "Support The Troops" as a smokescreen. The horrors of war are obscured by blaming the veteran. According to the propaganda, the high incidence rate of PSTD is ostensibly caused by personal defects or greed.
Bizarrely, the AEI recently held a conference in which it was asserted that veterans are chronically ill with PTSD because mental health professionals made them that way. It was not the horror of war that caused PTSD; rather it was the therapy, because mental health professionals believe that war can lead to PTSD. Bush mental health advisor Sally Satel takes issue with the mental health professional's expectation that in situations like war "threat and loss will predominate." She minimizes psychopathology by redefining symptoms as normal human traits, not illness. Consequently, veterans suffering from PTSD are not in need of medical care or federal dollars to pay for it.
Dr Satel, is the author of Is Drug Addiction A Brain Disease?, which recommends "... the use of ‘enlightened coercion,’ such as compulsory residential treatment..." and Who Needs Medical Ethics?, a discourse on how ethics discomforts some physicians. In her 2005 book, One Nation Under Therapy, she describes PTSD treatment providers at the VA as contributing to the problem because she "believes" that veterans could recover sufficiently with or without treatment so that they would not qualify for disability. Satel further states that the benefits themselves contribute to the illness. In a highly criticized New York Times op-ed, she attempts to discredit the diagnosis of delayed onset PTSD and claims it is the creation of anti-war activists, an assertion which only contributes to the stigma attached to the disorder and further dissuades those afflicted from seeking help.
In a recent Washington Post article Satel describes so-called underground networks of malingering veterans who conspire to obtain benefits. Her allegations are bolstered by fellow AEI psychiatrist Chris Frueh's statistics that significant numbers of veterans are "... misrepresenting the extent of their combat involvement "in order to obtain disability benefits. Frueh, who published his study in the British Journal of Psychiatry, bases this conclusion on a small sample of 100 consecutive records pulled from the Charleston, S.C. VA. He uses two "anonymous reviewers" to rate the war zone experience documented in the records. Anonymous review is an accepted convention in research; however, reviewer bias poses significant danger to the validity of the study. In this case, one reviewer with the initials of BGB may well be the study's co-author, listed as B.G. Burkett, also the author of Stolen Valor, the book which disputed the Vietnam War experiences of John Kerry and many other soldiers. Burkett, a Texas veteran and stockbroker, wrote Stolen Valor with Glenna Whitley, whose expert "diagnosis" has been reported as "It's really a 'guy' thing, with few exceptions." Whitley is a reporter in Dallas, Texas who, incidently, has also taken exception to the diagnosis of Munchausen's Syndrome based on a movie she reviewed. There is no evidence that Burkett is qualified as a professional analyst of military records yet BGB is described in the study as "an Army veteran with Vietnam war-zone service and extensive professional experience of analysing military personnel records."
Frueh's study concludes that "A small, but potentially significant, percentage of these treatment-seekers (5%) appear to have made false claims of Vietnam service or military service altogether." A closer inspection of the study reveals that 7% (n=7) of the records studied were of psychotic individuals, and it is therefore completely unremarkable that they may have inaccurately reported that they were POWs or engaged in "classified" combat activities. Frueh does not describe the inclusion/exclusion of these individuals in the group which "misrepresented" their combat service. This point is key, since if included, their psychoses certainly could put into question the validity of his conclusions.
Frueh finds it "...improbable that US military records would be so inaccurate as to offer no reflection of these experiences..." for the 5% (n=5) who made "false claims." It is imperative to reiterate that 7% were psychotic and 2% (n=2) of those treated never served in the military, which inevitably leads one to wonder why they were included in this study. The VA should never have treated them if they never served in the military. Additionally, Frueh's narrow definition of "combat exposure" may have even less significance in the current conflicts in which drivers, maintenance crews and other support personnel are regularly in harm's way. Frueh admits that the limitations of this study may prevent it from being generalized to a larger population and that "Another concern is that military files are not necessarily error-proof, and some veterans might have been misclassified." Remember, Frueh finds it "improbable" that the "records would be so inaccurate." In fact, however, medical documentation trainers endlessly repeat the mantra "If it isn't written, it doesn't exist," for it is not unusual for pertinent information to be missing from medical files. Yet the study's limitations were not broadcast when the results claiming significant fraud were publicized and consequently, the public was presented an unchallenged negative picture of veterans seeking treatment for PTSD.
While it is not disputed that there are indeed malingerers attracted to mental health care, veterans do not have a corner on the market. Further, it is expressly directed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) guidelines for diagnosing PTSD to be on the alert for that profile. Seasoned mental health professionals are well acquainted with drug seekers, "doctor shoppers" and others who are untruthful. Few of these prevaricators have Academy Award winning acting skills and most inevitably slip up. So, the accusation of "malingering" is a red herring. It is possible that to pose as a malingerer on the so-called underground networks is arguably more macho and acceptable than to admit to being shattered and in need of care. And there may be mental health professionals who conspire with veterans to get a cut of the pie, but, in committing fraud they have a very real possibility of getting caught, just as is the case with Medicare and Medicaid fraud. Malingering is the exception and not the rule.
The AEI presentation focuses on the value of keeping the "stiff upper lip," focuses on the value of reticence vs. the cost of emotional expression. Much like the "conspiracy of silence" element in incest cases, AEI promotes the notion that by simply not talking about it, the problem will diminish. Another AEI presenter, Simon Wessley states that the etiology of PTSD is often linked to preexisting psychological disorders and a history of trauma; however, as an advisor to the British Army Medical Services he readily acknowledges [.pdf] that "Denying military service to people with risky backgrounds for example would clearly have a serious effect on recruitment, especially for the army, which traditionally recruits from areas of social disadvantage."
Veterans advocate Kirt Love1, a frequent presenter at the Institute of Medicine (IOM), notes that the IOM will "Label these people as genetically inferior rather than physically damaged by outside sources." Indeed, there is a significant body of neurological research which focuses on the neurobiological changes found in subjects with PTSD such as decreased hippocampal volume, reduced activity in the prefrontal cortex, altered brainwave activity and increased activity in the amygdala. Dr. Brad Johnson of the U.S. Naval Academy states that "Various strands of medical research suggest that the intense bursts of brain activity during traumatic experiences may actually lay down new neural pathways in the brain — the prime culprits when it comes to the recurring symptoms of PTSD and the substantial difficulty finding a genuine cure."
The dictum that pervades the Iraq debate applies to the members of the military with PTSD; we broke it so we have to fix it. If the Federal government breaks a soldier in its use of that soldier to wage war on its behalf, then it is duty bound to pay to fix that soldier. That is the cost of doing business: An aggressive investigation of the neurobiology of PTSD and fully funding the VA demonstrates a genuine support for the troops.
It will certainly cut costs to blame the veteran for the psychological damage experienced in war through locating the source of that damage in morals, sin, and pre-existing pathology. But it is one thing to cut costs by using a cheaper grade of toilet tissue; it is entirely of another magnitude to cut costs by using disposable soldiers.
1. Private e-mail to D.E. Ford dated January 16, 2006
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Contributors: Zan, Cho, Standingup, Stoy, Vivian, JeninRI and lilnubber
Illustration by R. Stoy
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