Wednesday, December 30, 2009

PTSD - The Shadow of the Millennial Decade (Part I)

Interesting that as I was about to write a long post on the status of Post-Traumatic Stress Disorder (PTSD) as a diagnosis in the Diagnostic and Statistics Manual of Mental Disorders, fifth edition (DSM-V, new edition now due in 2013), AlterNet posted an article proclaiming the first decade of the 21st Century as the decade that made the US the PTSD Nation.

Here in the home of the brave, we've endured a decade that shattered nearly every notion of what it meant to be an American, whether you live on the left or the right. And so we shout. Or hide. Or startle too easily.

In America today, it seems we all have a touch of post-traumatic stress disorder, as evidenced by our increasingly vitriolic political environment, where reality is denied and histrionics run riot. Anger, we're told, is the natural reaction to trauma; in people with PTSD, the anger is out of control. By that measure, the millennial decade has brought us 10 years of PTSD politics -- with no end in sight.

From the Tea Party madness, the unwillingness of Republicans in Congress to vote for any piece of legislation drafted by Democrats, the misuse of the filibuster in the Senate to all but break the institution, and the outsized rage on the left toward the Obama administration for simply behaving as politicians do, our national politics have moved beyond the bounds of extreme partisanship into the realm of mental illness.

This breaking of the national psyche was bound to happen; it's been decades in the making. American exceptionalism -- the idea that we are somehow better and more blessed than any other people on the face of the earth by dint of our own hard work, ingenuity, innate goodness and superior democracy -- was bound to fail as our nation, like every other before it, found itself caught in the grinding wheels of history.

Rooted in denial, the doctrine of American exceptionalism edits out of the American story the sins against humanity that created our nation: the genocide of the people who were here before the Europeans came, and the building of the nation on the backs of involuntary laborers who were tortured, abused and even killed for their trouble. Once you ditch that, it becomes easier to look past the other unpleasant realities of our history, be it our neo-colonialism throughout the world, which helped to build our economy, or the enduring practices of racism and sexism. But denial almost invariably leads to trauma, when on one day, or in one decade, the decay that denial fostered summons home the demons set loose through willful ignorance to do their fright dance before one's very eyes.

It's a long article and worth the read. On the other hand, I wonder if a story like this (which does have its value) serves to confuse people as to the true, horrible nature of living with PTSD.

In Part I of this 2-part series I want to look at the PTSD diagnosis as it has been used (or not used) in the military, focusing on the current wars in Iraq and Afghanistan. Part II will look at possible changes to the diagnosis in the new DSM-V, due out in 2013, and how the disorder develops and might be treated more effectively.

PTSD and the Militry

There are many people who think that PTSD is just a liberal creation to keep soldiers from serving their country, not least among them are Rich Lowry (editor The National Review) and Brigadier General Rhonda Cornum (the Pentagon's new director of Comprehensive Soldier Fitness). This comes from a recent article at Huffington Post:
Now comes Rich Lowry, nationally prominent editor of the National Review, who mocks the soldier who plays the victim and indulges in "childish evasions." PTSD, proclaims Lowry, is a liberal media obsession.

In the same week the Pentagon's new director of Comprehensive Soldier Fitness gave an interview in which she said that the Army is spending too much time treating PTSD. Talking with the author Gail Sheehy, Brigadier General Rhonda Cornum said we should concentrate on the healthy soldiers and train the fittest to be able to absorb a "kick in the gut" and get back to combat.

American kids are pampered, Cornum told Sheehy. Their parents "bubble wrap" them. "Sometimes," she said, "you gotta package up your feelings and get on with the mission." Like Rich Lowry, the general seemed to think that kids whose brains fill up with images of horror are like computers. They should just push reset and erase the memory.

Clearly, however, there is something serious going on here. The rate of suicide among soldiers is at an all-time high (2/3 of which are in soldiers who have served in war zones), and has increased over each of the last five years. From Time Magazine:
The recently released figure for November show that 12 soldiers are suspected of taking their own lives, bringing to 147 the total suicides for 2009, the highest since the Army began keeping track in 1980. Last year the Army had 140 suicides.

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"Soldiers who are suffering from posttraumatic stress are six times more likely to commit suicide than those that are not," General Peter Chiarelli told the House Armed Services Committee on Dec. 10. "The greatest single debilitating injury of soldiers returning from Iraq and Afghanistan is posttraumatic stress." Nearly 1 in 5 soldiers — more than 300,000 — comes home from the wars reporting symptoms of PTSD. Army officials also acknowledge that substance abuse, fueled by repeated combat tours, and a war-created shortage of mental-health professionals, contribute to mental ills that can lead to suicide.

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