You made me think about something I never really considered before. For me personally I never connected "disorder" in a negative way with returning service members. But I completely understand your point.

I think as much as those who serve need whatever help requested when returning. The public needs to be educated to understand properly the whats and whys as best as possible.

No matter what you call it I will always honor the service, and never condemn those who have gone in to the places none of us would want to go in our worst nightmares.

Those who support the troops, will continue to do so sans any "stigma" in our eyes. Your strongest supporters will remain as such, so I agree...let's educate those who do not understand, to have the respect they should for service to the country and all of the wounds and life altering changes that are the cost of being a patriot.

Thank you to all that serve!

"De-stigmatizing..."
Yeah, UJ, that would seem to me to be the heart of the matter.

Part of the problem here is that PTSD is diagnosed by criterion set forth in the DSM-IVTR (http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_dsm_iv_tr.html), which is dependant upon certain benchmarks being met to be diagnosed. Naturally, you are applying a checklist modality to the spectra of psychological responses a human in extreme stress is exposed to. So, there are certain gaps that form. For instance, if you were, through counseling and whatnot, able to deal with you symptoms to such a point as that they no longer influenced your spheres of activity, then one could be considered 'cured' even though they still are very much preoccupied with that stressor.
If one has reached that level, then I think that they simply have "post traumatic Stress" since 'disorder' implies an interference in their ability to proceed in their daily activities without interference from the effects of combat stress.
I think that what would be helpful would be to come forth with a term that recognizes that someone has been exposed to combat stress, but that they are still functional. A kind of acknowledgement without the stigma. If this could be embraced and then propogated, then we may have an answer.

Why the term “Disorder”?
Short answer: The term “disorder” is a medical diagnosis, not a label affixed by misguided liberals of the Code Pink variety. While I agree that the “D-word” continues to be a stigma, the irony is that its application is what grants our Warriors access to the medical treatment they need and have earned. Even more ironic? The U.S. Army, literally, helped write the book on “mental disorders”. That’s right. The Army. Not left-wing bliss bunnies.
Long winded version: In the world of Medicine and perhaps more important –Medical Insurance- there are two primary gospels of diagnosis: The ICD-9-CM (International Classification of Diseases, 9th Revision) and the DSMIV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition). The primary difference? The ICD-9CM is for “physical” diagnosis and the DSMIV for “mental”. For example, the diagnostic code for TBI is found in the ICD and that of PTSD in the DSMIV. If you’ve ever taken a close look at the sheet of paper you’re handed after a doctor’s visit, you’ll see a list of medical conditions with numerical codes next to them. In the business of Medicine, those numerical strings are akin to “billable hours” in the land of attorneys.
Where did these numbers and the nomenclature that goes with them come from? I’ll point you directly to the source on that one:
The need for a classification of mental disorders has been clear throughout the history of medicine, but there has been little agreement on which disorders should be included and the optimal method for their organization...
In the United States, the initial impetus for developing a classification of mental disorders was the need to collect statistical information… By the 1880 census, seven categories of mental illness were distinguished - mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy. …
A much broader nomenclature was later developed by the U.S. Army (and modified by the Veterans Administration) in order to better incorporate the outpatient presentations of World War II servicemen and veterans (e.g., psychophysiological, personality, and acute disorders). Contemporaneously, the World Health Organization (WHO) published the sixth edition of ICD, which, for the first time, included a section for mental disorders. ICD-6 was heavily influenced by the Veterans Administration nomenclature and included 10 categories for psychoses, 9 for psychoneuroses, and 7 for disorders of character, behavior, and intelligence. (DSM-IV, Historical Background)
So, while I proudly wear Rangerup’s “I Club Hippies” shirt http://www.rangerup.com/iclhiblt.html, I have to cry “foul” on placing the blame of stigmatization on the bliss bunnies. The stigma comes from within our own community and if we want to change it, that’s where we need to start. Let’s be honest, do you think you’ll ever hear the words “Suck it up and drive on!” if you tell a hippie that combat has left you emotionally scarred?

PTSD is not a mental disorder by any stretch people. Clinicians use the terms to bill for it. However, it is as stated above a NATURAL response to seeing trauma that the human mind and heart was not designed to handle.

I work with people that have this label on a daily basis. Including their significant others and parents if need be. I have each of these people read a book called "Down Range, to Iraq and Back." Written by Bridget C. Cantrell and Chuck Dean. I am not giving a mindless plug here. It is by far the best tool I have in the arsenal for dealing with and helping those labeled with it.

I would suggest that anyone that can read this book. As a Chaplain you may all disagree and that is fine. I will say I have seen more damage done to these warriors by the VA and other entities all in the name of treating them as if this was a mental health issue. It just isn't. The label itself disrespects the scarifice the warrior accomplished in defense of our nation.

Was that "mindless plug" jab aimed at me? If so, I apologize for any offense taken. Sarcastic, smart a** humor is part of my writing style. The RU reference was meant to inject humor, not cheapen the message.

Thanks, Kriste! You're good... we welcome many inputs, sarcastic or otherwise !

Having a very minor case of PTS, I must agree dropping the "D" would be wise. After all, these are the same people that want to treat other psychological states that exist and pervade our society as 'normal', no matter how harmful they may actually be (laziness resulting in homelessness for example... and forms of sexual deviancy like pornography [I consider this more of disorder based on personal experience more so than the PTS]). Meanwhile, humans who face the stress of combat, something we have done and coped with since the dawn of mankind, are labeled with a 'disorder'.

I'll c&p what I said at BLACKFIVE --
htom said...

Partly, it's the stupidity of the way we pay for modern medical care. "Disorders" can be treated, experiences cannot be. Most people have not been in combat (or even close to it), so that is "normal", and the not-normal, abnormal, is thus "disordered". In that some who do experience combat seem to be able to shrug it off and go on like it didn't happen, there is some slight justification for the classification. I suspect that those ("ignore-it-ers") may be some of the most deeply damaged, such repression probably isn't healthy. I am neither a psychologist nor a neuroscientist, though.
May 19, 2009 at 12:35 PM

I think there is PTS and there is PTSD. In my experience (as Uncle Jimbo & others point out) PTS is the perfectly natural reaction to the stress of some event or combination of events that are HORRORS by any stretch of the imagination; combat is one of these. When the symptoms of PTS become intrusive, controlling and debilitating, PTS rises to the more chronic PTSD. If the PTS is not self-resolving, then it should be treated. And clinicians should not be required to diagnose "D" to be paid or to provide treatment when needed or desirable. The start would be to tell every Soldier and Marine that they WILL experience PTS and if you find that it bothers you or affects the quality of your life, you should seek treatment.

If all this isn't enough, you should read the proposed H.R. 952, the Compensation Owed for Mental Health Based on Activities in Theater Post-traumatic Stress Disorder Act, or COMBAT PTSD Act which would prohibit the VA from requiring a veteran to allege or prove that he/she was under combat stress in order to be compensated for PTSD... if you SAY you have it, the VA will [be made to] give you money. If you pay them, they will come. Ludicrous! The Congress is turning the VA into a social security agency.... and PTSD is the battering ram.

It could very well be that many look at this as a true problem and their hearts are in the right place(s). I doubt that.

I hope Carla's assessment carries weight, I too think all returning vets ought to hear "you WILL feel (think, act, etc...) different".

This fits into the left's meme of "victimizing" a situation. This allows lawyers the wiggle room to make $$ while allowing other lawyers a shot a moving legislation forward that is not always "beneficial" to those who protected the Constitution.

Given how our society revolves around court proceedings and the litigious nature of the current world we live in...assigning "mental Health" tags and issues will result in a restriction of freedom and possibly more for all vets. No tinfoil here...just think of insurance rates alone.

Wholesale categorization of wars and their effects is dangerous to the vets involved. But since we are such a minor hiccup in the over all population our voice is lost.

Warriors unite!!

I've been going to the local American Legion post (though I haven't yet submitted my application for the Auxillary), and when I attended a dinner for the Wounded Warriors participating in the Ride 2 Recovery, I met a local vet who is with an organization of vets for vets to help those who are dealing with Post-traumatic Stress, but without traditional methods of medicating to deal with it. I have his card somewhere. I'll have to look him up again. I tried getting him in touch with CJ so he could be a guest on the YouServed radio show...

Also, I care, but I don't - in my normal, day-to-day life - come in contact with combat vets. I don't really know what to say to them when they are strangers (it seems to be different when I communicate with my internet friends would are combat vets, since we are usually talking about something in particular and the focus isn't really on their combat experiences and how they are dealing with it) - they have experienced things I really have no concept of, no matter how much reading I might do - milblogs and books (House to House & Lone Survivor so far), it's still not the same. For our Wounded Warriors, being around people in wheelchairs isn't something out of the ordinary for me - my grandmother has been in a wheelchair since the 1950s - but my grandmother is not an amputee, as some of the Wounded Warriors I've met are. How do you balance wanting to be helpful with not making them feel helpless? I don't know. At the dinner, I know I talked to one (ambulatory) guy about baseball, since he was wearing a Red Sox cap, and I go to a lot of minor league games here in Austin. But, again, that was something - unrelated to his service in combat - that I could find as a common ground to make small talk about.

Another thing us civilians need to remember is that while we might be unaffected by certain things, combat vets might not be. At the Milblog Conference last month, I was privileged to attending the special screening of At War . While I found it to be a powerful film, I wasn't really affected by it; however, I heard others - combat vets - reacted differently, because it took them back to their own experiences. I would imagine that is doesn't have to be a documentary about the war to trigger those memories. But, as others have said, there is going to be a difference between PTS and PTSD (as with any traumatic event, combat or not). Civilians - especially those who interact with veterans - could use some educating on what is appropriate for us to say/do just in case we come in contact with someone who is still dealing with their personal experiences, and how to recognize what is "normal" and what is something that should require some sort of intervention, and options for getting the veteran the assistance they need. I freely admit I don't know enough, but I'm not in a position right now to where I need to be able to identify anything like that, so my ignorance currently does no one any harm...

Well, I've been up a lot later than I should have been...

Combat changes a person, period. Civilians may not understand the changes and may consider the changes negatively, but not all changes are as they are perceived.

Consider: Hypervigilance is considered a symptom of PTSD, as is paranoia. In combat and in training for combat, one learns to be aware of their surroundings. This is a positive change. It is not the "norm" for civilians, who then attempt to convince the veteran to "let his guard down." When he does, he becomes startled by things he knows he should have seen coming. He has attempted to change his behavior unnaturally. This unnatural change becomes an indicator of paranoia and jumpiness.

Add to this, the threat of losing 2nd Amendment Rights, if diagnosed with a mental disorder, and fewer Veterans will seek help.

The best books on what causes PTSD, how to prevent it, and help in overcoming it are by LTC Grossman: On Killing, and On Combat. Every Warrior and every one that deals with Warriors should read these two books.

Well said Uncle J. The victimization of Our Warriors is wrong. Until we can get the politicization of this issue removed, we will continue to have Warriors skip out of diagnosis and treatment for the negative effects that come with the positive changes. Unfortunately, too many are more interested in their bottom line and their electoral campaigns, than actually addressing meaningful ways to overcome this challenge.

Perhaps, it shoud be called PCA (Post Combat Attitude). Some things become more important and others less after having faced life and death on a daily basis. The latest hoopla over some celebrity contest may be shrugged off as inconsequential.

While many aspects of human personality may have evolved and become more complex over the millennia, I believe that the deepest levels of human nature have changed but little. And that specifically includes our propensity for organized group violence, and the human reactions of men participating in that violence. Reading the Iliad reveals the anxieties of Achilles, Hector and other warriors, in ways we can recognize. The warrior, then as now, feels the conflicting stresses of fear and aggression, of pride, love for comrades. Rage, and the internal conflict between fear of death or injury against the contrary fear of seeming the coward. It has always been thus, and warriors from three thousand years ago would have had similar biological reactions and felt the same stresses. What of the stress on the ancient Athenian hoplite, who slew his Persian or Theban opponent at arm’s length or even closer, looking his foe in the eye, smelling him, and hearing his cry as he is slain. Do you think such experiences left no mark on ancient warriors? Of course they did. Might those stresses be even more intense than those experienced by a modern rifleman? I have been neither a hoplite, nor a modern infantryman, so I can only presume from my more limited experience. But I don’t think the ancient warriors had an easier time. For my own time in the ranks, limited though it ahs been, I have been a far more perceptive historian. If you look at detailed portraits of earlier warriors you should be able to notice many traits in them, which we would today call Traumatic Stress. Many historic foible can be understood if you keep this in mind. But in those days, such things as prickly nervousness, a touchiness, or a hyper-alert sensitivity, maybe an overdone machismo, or a tendency to blow off steam in socially undesirable ways, were not generally considered as diseases, but as just aspects of the man’s character. And in earlier days, what we now call PTSD was probably common, even the norm in many societies, particularly those with a strong warring tradition. Such lingering psychological traces are quite rare in modern American and Western society where few see military service and even fewer see a combat zone. Those of us who have been to war are different, and it is evident, because we are so uncommon.

There is a passage in the epilogue of the Lord of the Rings trilogy in which Frodo and his companions of the Ring, later in life realize they are different from their neighbors, and set apart by their unique experiences. They come to terms with their special status be reflecting that they endured their travails specifically so that their neighbors could never be capable of understanding. They are special … because they are special. But that means their respect comes with lack of understanding. So it is for us. And I say thank God, that we with symptoms are rare – it means we have succeeded.

But today, our attitude toward stress is conditioned by modern society.
In part, PTSD is a phenomenon of the medicalizing of daily life. It seems that every aspect of our lives increasingly is reduced to a clinical phenomenon and assigned a diagnostic category and an ICDA code. Increasingly the Therapeutic Culture seeks to dominate every aspect of or civilization, with every imperfection and inconvenience seen as a disorder susceptible to the medical meme. Earthly perfection is supposed to arrive along with secular immortality. And distasteful facts are merely evidence of some perverse imperfection. Just like wrinkles and hair in the wrong (i.e. unfashionable) places. A prime reason for rejecting the existence of God – He created a universe not exactly in line with our conflicting and irreconcilable demands.
Of course, those of us who have served see some things a little differently. Perfection is not possible, particularly when all available alternatives are bad choices or worse.

I think another aspect of PTSD is that a disease and therapeutic model is essential if compensation is to be paid to veterans, real and imposter. Sadly the dilemma of compensation remains one of the central issues of the veterans care system. Secondary Gain is a crucial concept in any treatment case involving long-term disability. The patient’s incentive is not to get better, but to defend or increase his disability pension. Secondary Gain may also operate as an excuse, or as an attention-getting device, or in other ways to reward the individual for not getting better. In some cases, this may involve deliberate malingering and faking, but in many more instances, the motivation is actually internalized into the individual’s mind. And mental patterns are always far more susceptible than purely physical.

Within the VA system, there is also a problem that the VA honeypot attracts many, many frauds. The last census found 14 million Americans who claimed Viet Nam service, despite the fact that the entire Viet Nam era strength, for all services included only 12 million active duty veterans, of whom only 2.9 million actually qualified as Viet Nam service. Somebody not tellin’de troot’ dere. And I suspect that a large portion of the wannabes in the VA system have been treated for drug dependency and/or mental problems. Sure, no dispute, there are legitimate vets with such problems, but that is certainly where the wannabes roost. I’ve encountered very few people faking gunshot wounds and traumatic amputations. I worked within the VA system for seven years during the 1970s, and assure you that everyone in the medical system, at field station level, understood, and those days was very bitter about reality. How much recognition existed at Central Office level, I do not know. How much naiveté and how much cynicism? That’s academic.

As for my own PTSD. Personally I’ve never even applied. Reading the descriptions, I recognize myself, and probably would have managed to land an easy 20-30% had I sought it. But I refuse to acknowledge it as a disability or a disorder. It is part of whom I have become, and I would no more disown it than I would disown my baldness, my ethnicity, or my family name. In the words of that famous sailorman – “I yam what I yam”. I’m proud of it. I am a veteran and I have an excuse, but need none, not like that Napolitano whackjob who thinks I'm a threat.

Thanks to all for your thoughtful comments, that is exactly why I post controversial topics. I like to hear the discussion and the voices of all of you.

Cordially,

Jim

Thank you Jim for posting this topic and thank you all for your sincere and sage comments. I am reminded of another good book on Post Combat Attitude [love that!] called Achilles in Vietnam, by Dr. Jonathan Shay, who pioneered treatment on Vietnam vets in Boston. George Mellinger, I thought you were referring to that book--and thank you for your service.

I like the "Post Combat Attitude" nomenclature, as well. Not everyone dealing with Post Traumatic Stress is a combat veteran, as there are other traumatic experiences besides seeing combat (robbery and rape victims, people who have survived horrible accidents, etc.). Those who have seen combat, as others have said, are just experienced what warriors through history have experienced, and it is a unique kind of traumatic stress.

Since I do want to become more "hands-on" in my support of vets, I would still like some words of advice on what to say and what not to say, especially when I am just meeting someone and don't yet have common ground on which to base casual conversation. That is one thing that has made me hesitant/nervous about doing things like trying to get down to BAMC to volunteer/visit: my lack of experience in knowing what is appropriate...

I had to look up one of my old blog posts to verify it, but the VA rep at our demob referred to my CAB as a "30% badge," since it was prima facie evidence that I had been exposed to combat stress.

I didn't and do not want 30%. I wanted to stop dreaming about mortars.

There are compelling reasons to seek help. There are also very compelling reasons NOT to. I'm in a National Guard military intelligence unit; many people in my company make their day-to-day living using their dearly won security clearances to support the nation's defense. Whatever assurances we are given, there is the widespread concern that going forward with combat stress issues will suspend clearances and put some of those people out of jobs. You throw that on top of the more conventional concerns, and it's not surprising that people choose to try to deal with it on their own, or through alternate channels.

B. Steele -- The idiots we will have with us always. I'm very inclined to think that those suffering with PTSD who are getting help are very much less likely to have future problems than those suffering who are NOT getting good help. Just the concealment is going to add a layer of problems that have to be dealt with! (Now what constitutes good help is a thorny question; the VA might not be the best available route for supplying it for some patients because of those external fools.)

just got message to Genie Z and I am letting everybody know about this letter.

Genie Z,

In my contact with the local VFW post, I have learned of a Vietnam Veteran who is facing the loss of his home due to financial hardship. He and his wife sold their home last year and moved in with her mother and father to help pay for escalating medical bills. She died as a result of a long, protracted illness and now they are so behind in their bill payments that creditors are calling daily, in addition to the funeral home demanding payment. Dealing with these creditors and the possibility of the loss of their home, this veteran, Alfred Peak, is now having terrible flashbacks to his days in Vietnam and is suffering from extreme PTSD. The father-in-law is 80 years old and is drawing $700/month in Social Security; Alfred is receiving only $260/month in disability payments. He has an appeal with the VA pending but does not have any idea what will happen there. Their house payment is $440/month and insurance is $276/month so you can see that they are really hurting now financially.

The VFW learned at Christmas that they were living on crackers because they could not afford food and has been taking food to them regularly. The VFW is holding a Benefit Dinner for the family tomorrow and the cost of a dinner is $5 but our town is so small that I fear that they will not be able to even make a dent in this problem.

I hate to ask anyone for money, especially now, but my heart is breaking for this family. I am asking you to donate just $5 to this cause and see if we, as a group, can make a difference. The address to send your donations to is:

Donnie Phipps
VFW Post 1184
981 Little Creed Road
Dublin, VA 24084

Thank you for standing with our Vets. GOD BLESS YOU ALL!

Nice post Jim

All this time I thought you were just a bratwurst eating cheese head who made a career out of acting like the class clown.

Bill