Joint Chiefs chairman wants PTSD screenings
Looks like universal screening is coming...I'm interested in who the "mental health professionals" will be.
http://www.usatoday.com/news/militar...-12-ptsd_N.htm
The Pentagon's top uniformed officer is calling for all returning combat troops, from privates to generals, to undergo screening for post-traumatic stress with a mental health professional, a move aimed at stemming an epidemic of psychological issues among veterans."I'm at a point where I believe we have to give a (mental health) screening to everybody to help remove the stigma of raising your hand," Mullen said. "Leaders must lead on this issue or it will affect us dramatically down the road."
I am doubtful as to whether this is the right way to go. PTSD screening is based solely on patient disclosure. It is not like a blood draw to look for an antibody, some soldiers have a pretty good idea what they can safely disclose and what they can not to either receive or avoid a PTSD diagnosis.Originally Posted by MikeF
Reed
Hey Reed,
Not to be the devil's advocate herein, but what exactly is a pretty good idea what can be safely disclosed?
What happens to a returning soldier diagnosed with PTSD? He/She enters rehab, no longer fit for promotion, no longer eligible for yet another tour in Iraq?
I know there were some when I retired who flat out refused to disclose health issues, but that's slightly different when entering the civilian world without sight or hearing. Or is it?
Regards, Stan
If you want to blend in, take the bus
Depends on the field and to a greater degree the chain of command. If the soldier needs a top secret clearance for there job then promotion is certainly at risk. They risk being med boarded out, being sent to the WTU, which on some posts are despised. If the soldier is not sent to WTU or med boarded out, then they are able to return to future deployments, though this was not always the case. Failure to get PTSD treatment will result in long term detriments to physical as well as mental health.
Many educated soldiers are aware that the intrusive memories aspect of PTSD is the key to diagnosis and will withhold disclosure if they do not want the PTSD stigma or falsely disclose it if they are malingering (it does happen, but not as often as some people fear IMO)
The article comment about a therapist being able to diagnose PTSD in five minutes is complete Bravo Sierra, and if I were ever to catch wind of a counselor doing it, I would be slinging HEAT rounds like it was going out of style. Takes a great deal of time to accurately diagnose PTSD and even then it is not an exact science by any means. I hope managed to communicate my points clearly.
Reed
ptsd and clearances
SEC Gates released guidance this year that for Security Clearance Applications and Investigations, the question covering seeking mental health or counselling will be amended to exclude combat deployment related issues.
They are trying to encourage people to get help, and not hide issues which only makes them worse. Unless the medical issues are so great that the Soldier cannot function, commits violent acts, or abuses alcohol/drugs, it should not come up in his/her security check. If the Soldier is doing those things, he/she needs help.
Well said Reed
I'm gonna have to step out of academia and put my stetson and jump boots back on to dive into this one....
Any "mental health specialist" clown that thinks he can diagnose PSTD within five minutes should be rejected from any military sponsored assesment. The majority of my TBI soldiers lied to the medics, Docs, and 1SGs to get back into the fight. After 8-10 IED attacks, I forced them into submission. Now, they are trying to recover. Don't be fooled to be fooled with the assertion that universal assessment is the magic answer- the boys (and girls) can outwit any psychologist/psychiatrist looking for causation. Unfortunately, those truly affected with PTSD will surround themselves with layers upon layers of defense.
Others, the self-described 'victims' of the war- will tell any tale to receive benefits undeserved.
One of my best soldiers is currently in a WTU. He shared the following humorous story.
"Sir, I was given a free fishing trip for four wounded soldiers. In the WTU formation, I asked if anyone would like to take it. 30 soldiers came to me wishing to attend. I told them that only combat veterans could take the trip. 25 walked away. WTF??? Sir, what is going on here?"
I couldn't answer him. For the first time, I had to tell him that there was nothing I could do.
Back to Reed's original post. What do we do? What do we do for the warriors not the victims?
I don't know.
v/r
Mike
Last edited by MikeF; 10-14-2008 at 06:33 PM.
True, and hats of to SEC Gates for having the courage to do the single thing that would have the greatest effect on MH stigma. However this is going to take time to filter down from the top, and for soldiers, a closed minded or uninformed chain of command is often the greater immediate threat from a MH diagnosis.
To step back to Stan for a minute, you actually made an extremely valid point that I failed to address on my first response, what exactly DOES happen to a soldier diagnosed w/ PTSD? There is no one answer and it is very chain of command driven. I have seen soldiers that were a train wreck that the chain of command denied counseling for because they were afraid to lose the soldier and soldiers that certainly had some degree of PTSD that commanders refused to allow to have counseling because they were afraid that it would prevent there ability to discipline and rehabilitate the soldier. On top of this Army civilian MH providers vary greatly in quality. Some are fantastic, unfortunately my personnel experience is that most are not. I have seen them belittle patients, mis-diagnose, over-diagnose, over-medicate and show greater allegiance to the process then the client. Same goes for many VA clinicians. I have also seen superb chain of commands that have made referrals when appropriate and dealt with less then clinical challenges in-house very effectively.
My focus is PTSD awareness training for first-line leaders to help them differentiate between MH and disciplinary issues and stress self-help skills for the individual soldiers and families. Army chain of commands seem to universally care about there troops, so I feel this will help reduce a lot of the chain of command errors I have seen. It's a start anyway.
Reed
Last edited by reed11b; 10-14-2008 at 07:04 PM. Reason: toning it down a bit
So, I imagine this will be yet another mandatory, unpaid requirement for reservists, that will potentially jeapordize our freedom and constitutional rights? (No, sir, you can't own a gun. It says right here, that you've been diagnosed as having PTSD....)
I will quit the military before I allow some worthless M/H hack the power to stigmatize me for life.
My own story of Medical Service Corps incompetence includes being put on "Indefinite Medical Hold" for a childhood hearing loss, upon my return from Iraq. We're now on the cusp of giving even more power to these worthless, incompetent hacks.
Show me a Medical Service Corps officer with even a scintilla of honor, and I will eat my hat....
My mother in-law was a senior psychiatrist working at the Richmond Vet Admin hospital with a specialty post traumatic stress disorder. When she retired they moved her entire case load to psychologists. They called her back to consult on several cases because they had so many suddenly having issues. A psychologist is not a psychiatrists no matter what they say. It is a cost saving measure. When she left they were clocking her time (keeping track) which was part of an efficiency metric. I don't know the details and what I've stated is basically all I think I know about it as I'm not that close but there seems to be issues in the system
Sam Liles
Selil Blog
Don't forget to duck Secret Squirrel
The scholarship of teaching and learning results in equal hatred from latte leftists and cappuccino conservatives.
All opinions are mine and may or may not reflect those of my employer depending on the chance it might affect funding, politics, or the setting of the sun. As such these are my opinions you can get your own.
A history lesson...
Remember all the VFW halls when we were kids, with the old guys from WWII and Korea? The cheap beer, BBQs and BS sessions where a home-brewed version of peer counseling for PTSD.
So these spiffy programs with fresh-faced, shiney happy counselors are going to share exactly what frame of reference with the guys getting off the planes from Kuwait?
If you want to effectively treat PTSD, A) you're going to need BTDT counselors and B) you're going to have to leave the door and/or phone line open for when Joe gets around to admitting to himself "I need to talk to that counselor guy".
Next year will be the second and LAST time I'm demobbing : there'll be one thing on my mind - 1. how fast can we do this Kabuki dance and 2. when do I see my girlfriend? My motivators at that point will be the same as Joe's, even tho' I'm a (comparitively) old guy and I'm aware of the importance of monitoring my own emotional state.
You want to make this work, with limited resources in Alaska? I'd whistle up your state VFW coordinator and work with him to create a gateway for us - so whether it's the day after we get home or three years later, we can reach out for someone to talk to and not necessarily have to do it after two or six pitchers of Bud.
A scrimmage in a Border Station
A canter down some dark defile
Two thousand pounds of education
Drops to a ten-rupee jezail
http://i.imgur.com/IPT1uLH.jpg
Torn on the subject
First let me say I do think there are those that truely need help, have come across some of the finest fighting men in the world who have reached there mental limits and broke. On the other hand I see this as the new exit strategy for anyone who does not want to truely earn their paycheck and that ever so popular college money.
In my opinion this doesn't need to be addressed by outside organizations as an all encompassing answer. Nothing pisses me off more than having to get off a plane only to get on a bus to take me to get some screening before I can go home to the family. To many this is a cause of issues more than what they experienced during their deployment. The responsibility truely lies on every single one of us in the service today. It is our responsibility to know our peers, subordinates, and superiors. Only when you know those around you can you tell when something is not right. We are afterall only human and some things affect us differently than others and we all have a breaking point. To think these mental health types can figure some of us out is the best comedy I have come across. An example of this is the fact that a majority of those I work with including myself fail every psychological exam we take, why is this? Am I a sociopath? Ask my wife and she will most definately tell you yes, yet I am not out running around killing people in my spare time. Simple answer is do I have the capability to things many others do not, yes but also do I have a clear cut line drawn on when to use that capability and when not to, yes. I have done it for years, who I am at work is not who I am at home.
I have seen a few who have "broke", the unit moved them into a different position for a while to get their mind right, to come to terms with what they were dealing with, and they are back in the fight as I type this. Unfortunately too many organizations and individuals have their hidden agendas and thus we end up with what we have now.
Just my .02 from what I have experienced.
ODB
Exchange with an Iraqi soldier during FID:
Why did you not clear your corner?
Because we are on a base and it is secure.
Good point Adam. It was just following Zaire's first uprising and civil war and State decided to send us a USG shrink to make sure we were still OK. My boss MAJ D elected I take our Boston Whaler with 90 raging ponies across the river and retrieve the shrink at dusk. As luck would have it, Zaire and Congo were exchanging tracers and the light show was up to its usual fantastic. I think I made it half way across the Zaire river when the shrink hugged the hull and begged to be returned to Brazzaville.
... We (I) never saw him again
If you want to blend in, take the bus
Amen to that...
Good units fix their problems. Unfortunately, for the last 30 plus years, the Army has failed to push that philosophy and punish those who fail and has instead elected to punish everyone for the failures of a few...
Blanket 'remedies' almost never work.
Sounds like the Army tenets of combat stress control. PIE, Proximity, Immediacy, and Expectancy. They are key to army stress control for a reason, there success rate is high. But not 100%. We still owe it to those that it does not work for to have effective readjustment programs in place.
I also agree that blanket solutions do not work, but there is a lack of awareness by the chain-of-command about many non-medical social service programs available for there troops. Blanketing individual troops w/ briefing after briefing IS counter productive ( I have been a participant on both ends of many a "briefing too far" myself) but awareness needs to be there. ACS is a start, but they should be developing connections w/ the units and I have not seen them do that at the bases that I work with. As I have stated earlier, I feel the key is training leaders in a professional and respectful manner (i.e. NOT by power point briefing) how to recognize possible warning signs and to what resources are available. I say this because I still meet Co. level leadership and higher that does not realize that soldiers can see Vet Center counselors as well as Army Behavioral Health and that Vet Center records are not shared w/ the DOD. Again, thanks for the feedback and please keep it coming, even if only to say you do not like or trust my chosen field.
Reed
And that is exactly why my goal is to become a Behavioral Health Science Officer. I have some "been there-done that" under my belt and can meet the soldiers where they are at both physically and in context. Again, Vet Center counselors are currently running at about 80% combat veterans.Good point Adam. It was just following Zaire's first uprising and civil war and State decided to send us a USG shrink to make sure we were still OK. My boss MAJ D elected I take our Boston Whaler with 90 raging ponies across the river and retrieve the shrink at dusk. As luck would have it, Zaire and Congo were exchanging tracers and the light show was up to its usual fantastic. I think I made it half way across the Zaire river when the shrink hugged the hull and begged to be returned to Brazzaville.
... We (I) never saw him again
Reed
Dissociation
Had to pull back from this thread a couple of days ago - too many Ghosts of Christmases Past came back to haunt - a confluence of several stars which are now back to their places in the firmament (in an improved condition). All that Bravo Sierra means that I really don't want to (shouldn't) get into this discussion much.
But, the references to "sociopathy" (by so many here) continues to bother me. I think the process (that is, Ken's 30% who can hack violence and can continue to do so) is a form of dissociation - here, I think, a positive form of dissociation.
Here is a Wiki ref to dissociation - mostly aimed at the clinical type, but useful anyway.
http://en.wikipedia.org/wiki/Dissociation
I am talking more about a sub-clinical type, which I will try to describe. Situation of physical danger; mind (Ego, whatever you want to call it) separates from body; situation of great clarity with body responding as mind directs (but Ego is not really directing, you can see the whole scene unfold with great clarity without being involved - I can't be killed or hurt); no wasted moves; threat resolved; mind and body back to normal. QED.
Now, there is some long-term cost to all that, which I won't discuss here. But, is what I described something that others here have experienced ? Am I making any sense ?
Makes a good deal of sense, JMM. No worries there. Personally, I think we as a society tend to be far too quick these days to smack a "...pathy" or other sort of tag on things that really might not need them at all. I also think that (in line with what Adam posts) that in this day and age of supposedly instant communication and the supposed comprehension that goes with it that we miss some of the more basic forms of communication (as in face-to-face listening). Technology won't fix everything, no matter how much some may wish it, and neither will slapping labels on everything.
"On the plains and mountains of the American West, the United States Army had once learned everything there was to learn about hit-and-run tactics and guerrilla warfare."
T.R. Fehrenbach This Kind of War
A bunch of the stuff you are talking about (sociopathy, psychopathy) are determined by outside factors like culture and environment. It is a clinical illness to be paranoid unless everybody is out to get you. Part of the problem is the way society deals with violence. In "Violence: A microsociological theory" Randall Collins says that humans just plain aren't wired to do violence and to prove it extensively based his argument on SLA Marshall.
A variety of people have refuted Collins and Marshall over the years.
The willingness to engage in violence, or acts of violence in a targeted and efficient manner is neither understood or explained well in the literature. Basically because it is a POLITICAL issue.
The various clinical descriptions for ailments of various soldiers can usually be classified into a few different buckets. The problem is that people walking around the street at random can be picked up and fall into similar buckets having never been to combat.
One BIG thing that has to occur is a-political analysis of the issues involving dissociative traumatic stress and brain injury due to experience must be done soon. Another thing is that people doing the studies need to remember that their political dislike for violence should not be allowed to taint the research.
I'm not saying people don't have problems but I am saying the way we treat people is based on highly flawed and politically skewed mumbo jumbo (mumbo jumbo is a scientific term of bull ####).
By the way after I posted my review of Randall Collins book "Violence" he quit speaking to me.
Sam Liles
Selil Blog
Don't forget to duck Secret Squirrel
The scholarship of teaching and learning results in equal hatred from latte leftists and cappuccino conservatives.
All opinions are mine and may or may not reflect those of my employer depending on the chance it might affect funding, politics, or the setting of the sun. As such these are my opinions you can get your own.
No scientific backing just a thought
I have wonder for quite some time now about PTSD in todays services vs those in the past. I know there are entirely too many variables to really put a finger on it. My biggest questons are is it more widespread today because now people know what PTSD is and diagnose it as such or is it because society today is much easier than it was 20, 30, 50 years ago therefore people are not as desensitized as they were before. Having led easy, stress free lives today compartively to previous generations. I know the stresses today are different than in the past but generally speaking life is easier than in the past for most. Ultimately is it a combination of both? The services themselves are falling into the trap in mind as well of taking the stressors away that very well may have been the reasons for fewer cases in the past.
I wanted to touch on a previous post about the VFW and what therapy a case of beer and some good BBQ with those you were there with you can do for one. In my opinion it should be built into rotations, 2 weeks as a unit with lots of alcohol and good food, in some sweet resort for all in the unit to decompress and support each other. Part of the issue in my mind is that too many today have lost sight of what a "team" truely is. If only I was the hog with the fuzzy nuts.
Just curious what others thoughts are on these.
I am of the thought if we can figure out who is most and who is least suspect to PTSD then we assign them accordingly throughout the services. In my opinion prevention vs rehabilitation is where we need to look.
Last edited by ODB; 10-18-2008 at 01:32 AM.
ODB
Exchange with an Iraqi soldier during FID:
Why did you not clear your corner?
Because we are on a base and it is secure.
Couple of points on your good post.
First, recall that in WW I, WW II, Korea and Viet Nam, rotation was individual and not by unit. So you went to war, got through as part of a unit -- and then returned to CONUS as a single soul. What you then did was work through any problems pretty much on your own; most people just sucked it up and kept on plugging along. A few had severe problems and got local or VA help, most did not and worked things out for themselves. Most were content with that.
After Viet Nam, as a result of many things (not least getting a diagnosis insurers would pay for), interest in PTSD rose and for the first time, counseling was offered. A really relatively small percentage of Viet Nam veterans were involved in that -- most just drove on as had their equally numerous Korean War predecessors and their far, far more numerous WW II forebears...
Secondly, I agree that society has lost many stressors and that treatment for mental aberrations is more acceptable and those two factors conspire to raise the acceptability and thus the number of 'sufferers.' Times change and so do mores an attitudes.
Not always for the better...
As an aside, I agree with your idea on unit rotations decompressing on the way home.
And I really agree with your 'prevention is better than treatment...'
Last edited by Ken White; 10-18-2008 at 04:51 AM.
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