I found this article to be really interesting on PTSD
Controversy Builds About the Prevalence of PTSD in Vietnam Veterans
Below is an article sent to me by our Veterans Advocate Paul Sutton.
As
most of you know there is a raging battle since Vietnam of what
constitutes Post Traumatic Stress Disorder (PTSD), is it curable, or is
it only treatable with minimizing some of the effects of PTSD, is it
even recognizable in its infancy, is it a life long disorder, how long
does it take to diagnose, how many visits, and what is the proper
methodology; and on and on.
In
addition, there seems to be a battle between the medical doctors and
the psychologist and psychiatry in general regarding this issue.
I
cannot stress enough the lack of taking into consideration the
neuropsychological and neuropsychiatric effects of the herbicides used
in Vietnam. That is the first rule of DSM-IV.
Yet,
it seems it has been totally ignored because of the Veterans cost and
possible incrimination of the toxic chemicals themselves.
NEUROLOGICAL AND NEUROPSYCHIATRIC EFFECTS
Many
times, I have posted findings of Ranch Hand found neuropsychological
disorders, Army Chemical Corps findings of increased mental disorders,
IARC findings of personality changes when exposed to the dioxin, TCDD,
Dow Chemical statements made in 1965 of neuropsychological disorders
associated, Harvard medical studies, EPA has reported mental faculties
disorders which I would think could be found as PTSD symptoms or at
least confused as part of the diagnosis. If one looks at the reports of
mental disorders found significant, not diagnosed as PTSD but found as
separate issues such as mood disorders, schizophrenia, anxiety, panic
attacks, depression; Ranch Hand alone found statically
significant excess in - psychological disorders of depression,
somatization, and severity of psychological distress. Antisocial and
paranoid scores were significantly higher along with psychotic
delusion. I would also add in the chemical company workers themselves
sent into clean up toxic spills, forest workers, rail road workers and
the increase in suicides is also part of this complicated equation.
Even the CDC noted:
"In the 1988 Psychosocial Characteristics part of the Vietnam Experience Study (VES), <172> the CDC
found
that among Vietnam veterans, certain psychological problems were
significantly more prevalent, including depression (4.5% vs. 2.3%; odds
ratio = 2.0; 95% C.I. = 1.3 - 1.8) and generalized anxiety (4.9% vs.
3.2%;
odds ratio = 2.0; 95% C.I. = 1.1 - 2.1). About 15% of
Vietnam, veterans experienced combat-related posttraumatic stress
disorder at some time during their military service. Depression and anxiety were not restricted to the group of veterans having posttraumatic stress disorder. "
If
you took three or four of these disorders as a sum rather than
individual disorders in a report could you not diagnose as PTSD; or did
you miss PTSD. I think the answer is obvious and very confusing as what
part is trauma and what part is a neurotoxic chemical. So yes, it is no
wonder doctors have a hard time defining what is PTSD in Vietnam
Veterans. Moreover, certainly this why in some cases decades after the
trauma our Vietnam Veterans are diagnosed with PTSD as the toxic
chemical effects manifest.
Nevertheless,
assuming there were no toxic chemicals; can we put a time line on as VA
has done in the past with the toxic chemical damages? The answer is no.
Many
Veterans turned to drugs, many to alcohol or both and some turned into
working themselves to death to avoid the confrontations.
As
they get older, they can no longer work as they once did and finally
they have to admit there is an issue and have been in their life since
their return from war. They have to admit that in many cases, they were
wrong and it was not the world and their family that was wrong in every
case.
Most
of these men will not have made many friends since returning from
Vietnam. They may have workers at work they have to get along with or
in some cases not and they lose their job. They have a few
acquaintances but that is about it; as a strong indicator.
Now
I did not make this up. This is a result of talking to two VA mental
health doctors for at least 16 weeks twice a week that run a very good
program on recovery.
The
one thing that really disturbed me was the one doctor said in 16 years
no one from VA benefits had called him to discuss a case. How VA can
deny any case without talking to the treating VA doctor is about out of
my capability to rationalize. Obviously, they can and do more often
than not.
I
think from my experience with these doctors the first thing is to get
to the Veteran that there is a potential problem early on in his or her
life and what to look for not only by the Veteran but family members as
well - then certainly they will have better quality of life. He or she is then given the tools to recognize the symptoms and then seek treatment in both counseling as well as medication,
if needed. In most cases the medication and counseling go hand and
hand. The Vet feeling somewhat better because of intensive counseling
then goes off the medication without the doctors consultation. The two
steps forward are now taken four steps back.
This
disorder seems to require constant diligence of observation in 'actions
as well as reactions' both physical as well as mental and the tools
given the veteran to identify and change those outcomes.
Below is the article and this continuing saga of PTSD.
Controversy Swirls Around PTSD in Vietnam Vets
Military.com | Law & Health Week | August 31, 2007
Controversy Builds About the Prevalence of PTSD in Vietnam Veterans
Newswise
— Controversy continues to swirl concerning the findings of a landmark
study that estimated the percentage of Vietnam veterans suffering from
posttraumatic stress disorder (PTSD).
Traumatic
stress experts have renewed a clash over the results of the 1988
National Vietnam Veterans Readjustment Study (NVVRS), which originally
estimated that 30.9 percent of veterans endure the effects of PTSD
during their lifetime, and that 15.2 percent still suffered from PTSD
more then ten years after the war. The actual prevalence of PTSD in
veterans is vigorously debated among the field’s leading researchers,
with long-lasting public policy implications for veterans of all U.S.
wars, including the current conflict in Iraq.
New
opinions by several parties involved are reported in the August issue
of the Journal of Traumatic Stress, published by the International
Society of Traumatic Stress Studies (ISTSS).
Bruce
P. Dohrenwend, PhD, of Columbia University, et al. conducted a recent
reanalysis of the NVVRS, which found an 18.7 percent prevalence rate of
lifetime war-related PTSD and 9.2 percent of current PTSD at the time
of the study. The authors say that the finding of lower rates is the
result only of differences in the definition of the disorder and does
not represent a significantly lower total number of soldiers impacted.
The
key finding of their study, according to Dohrenwend et al., was that
the NVVRS confirms a “strong dose/response relationship between
severity of exposure to war-zone stressors and PTSD.” The more soldiers
are exposed to the horrors of war, the more likely they are to suffer
from posttraumatic stress.
Richard
J. McNally, PhD, of Harvard University, argues that the original NVVRS
and the more recent Dohrenwend reanalysis overestimated the prevalence
of PTSD in veterans by using faulty criteria for diagnosing the
disorder. According to McNally, 5.4 percent of Vietnam veterans showed
clinically significant functional impairment at the time of the NVVRS
study.
“Eliminating
cases who exhibit no functional impairment is an important way to
address a chief concern of the NVVRS’s critics,” said McNally. “Not all
emotional changes wrought by serving in a war zone are symptoms of
disease or disorder.”
A
number of experts disagree with McNally’s interpretation of the data,
including the original authors of the NVVRS study. William E.
Schlenger, PhD, of Duke University Medical Center, et al., claim
McNally misrepresents the findings of Dohrenwend et al.’s analysis.
“[McNally’s]
erroneous statements and misrepresentations seem clearly to be not
random,” said Schlenger et al. “Instead, they appear to have been
crafted to support a specific bias that has significant policy
implications, i.e. that PTSD prevalence among Vietnam veterans is a
minor problem, and the real problem is veterans faking combat exposure
and PTSD symptoms to qualify for service-connected disability.”
According
to Dean Kilpatrick, PhD, of the National Crime Victims Research and
Treatment Center Medical University, “In my view, the reexamination by
Dohrenwend and colleagues is a major contribution to this public policy
debate…It confirms that most veterans of the Vietnam War were
resilient, but that an important subset continued to have PTSD over a
decade after the war was over.”
Despite
disagreements on numbers and methods, the experts concur that the
government has a responsibility to adequately treat veterans with PTSD.
“Regardless of [frequency], the central issue is whether resources are
sufficient to meet current demand,” said McNally. “The key question is,
'If a veteran seeks mental health care, will that be able to obtain
prompt access to state-of-the-art, evidence-based [care]?’ If not, then
we must increase resources."
The
International Society for Traumatic Stress Studies is an international
multidisciplinary, professional membership organization that promotes
advancement and exchange of knowledge about severe stress and trauma.
Copyright
2007 Military.com. All opinions expressed in this article are the
author's and do not necessarily reflect those of Military.com.
From the August issue
of the Journal of Traumatic Stress, published by the International
Society of Traumatic Stress Studies (ISTSS) via Military.com.
Note the disagreement with these study results by the one of the original authors of the NVVRS study, William E. Schlenger.
