Tags: Post-Traumatic | Stress | Disorder

Post-Traumatic Stress Disorder

Wednesday, 23 March 2005 12:00 AM

Inclusion in the DSM matters, as it virtually defines what conditions might be covered by insurance, admissible in court as explanations for conduct or grounds for divorce, or render somebody unfit for employment or security clearances.

Combat-related PTSD is so real, in fact, that the DSM cannot address it adequately. A bureaucratic document, the DSM prescribes a list of symptoms for PTSD (as for all conditions). Diagnosis requires that the patient exhibit at least some of the major ones.

But perhaps it would be more apt to think of PTSD as akin to hay fever or allergies. Everybody has them. For some, it's so mild they never even notice. Others are incapacitated. And over the course of a lifetime, the symptoms and their severity can change many times.

PTSD is very real. But it also gets used by people with agendas far beyond the therapeutic.

PTSD got into the DSM after a decade of lobbying by a curious alliance of anti-war psychiatrists and Vietnam veterans advocates and groups.

The shrinks wanted to use PTSD to make political statements, and subsequently fought to expand the definition to the point where, at least according to some, merely living in the nuclear age was traumatic.

The Vietnam veterans advocates, furious at the poor treatment afforded Vietnam vets by the Veterans Administration (later Department of Veterans Affairs) and angry that the traditional veterans groups, such as the American Legion and VFW, weren't taking them or the issue seriously, used the issue to increase their own clout. And now, a panoply of agendas is kicking in.

First, let's dispose of the obvious. The military has a vested interest in minimizing the incidence of PTSD among its active personnel. It wants them fit and functioning. The veterans establishment has a vested interest in maximizing the incidence among veterans. It wants veterans treated, which means it wants the money and the influence that major spending bring.

The anti-war movement, unable to attract popular support any other way, feeds (as it did during Vietnam) on tales of horror and woe. And, sadly, some returning veterans, and some who never went, pass themselves off as more afflicted than they are, for whatever reasons or demons may drive them.

And one group seems to be garnering more than its share of stress: women deployed overseas, and especially those who experience combat.

Erin Solaro, a Seattle-based writer, spent a month in Iraq last summer as a journalist embedded with combat troops in the Sunni Triangle, and recently returned from a month in Afghanistan, embedded with Provincial Reconstruction Teams. Her mission was to observe American women soldiers, especially those attached to small combat units, a practice that the Army has only recently and grudgingly admitted. She regards the current situation of American female soldiers as "schizophrenic."

Says Solaro:

"These women who are now routinely going into combat were told by the Army, and many believed, that they would never see combat. The Army lied. You can't announce that, 'In this war, there are no safe rear areas' and that 'Everyone must be a rifleman first' – then tell women they'll be safe because they're assigned to non-combat units. Even worse, these women never received proper training and indoctrination. This creates a situation in which they can't trust themselves and their male comrades can't trust them."

As for the related issue of sexual assault and harassment:

"The only thing worse for a woman than going into combat unprepared is going into combat alongside men who've been harassing and raping her."

And yet, Solaro sees another pattern, another standard emerging.

"The women I saw in Iraq and Afghanistan learned quickly. The units I was embedded with had no sexual problems because their commanders and leaders demanded high standards and punished lapses. Some units can be hell because these crimes cluster."

Solaro further notes that the Army has to do three things now. First, adopt a zero-tolerance policy toward harassment and assault and start making examples. Second, start seriously training all women for combat. And third, start giving women full and proper due for their service.

This won't eliminate all PTSD, but as a start will make it easier to bear and to treat. And it's the right thing to do, for it recognizes the burdens and contributions of women to the nation's security.

Robert J. Cihak, M.D., is a Senior Fellow and Board Member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues.


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Inclusion in the DSM matters, as it virtually defines what conditions might be covered by insurance, admissible in court as explanations for conduct or grounds for divorce, or render somebody unfit for employment or security clearances. Combat-related PTSD is so...
Wednesday, 23 March 2005 12:00 AM
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