Andy Whyman: The impacts of Post Traumatic Stress Disorder
In the late 1970s, a well-dressed and distinguished-looking man in his 30s came to see me in consultation. He felt troubled — troubled by nightmares, intrusive memories and compulsive behavior he knew to be odd, but which, for a time, he could not stop.
Gradually, over several visits, he told me his story. A Columbia University graduate, he was drafted and served as a squad leader in Vietnam. Soldiers were killed under his command.
After first returning home, he felt, for months, compelled to carry a loaded weapon to the roof of his apartment complex at night where he patiently sat … waiting.
He began a successful career, but suffered nightmares and intrusive recollections about those deaths, coupled with an unshakable guilt that he was responsible for them.
For several weeks, we explored the details of his Vietnam story. His “symptoms” receded and, feeling better about himself, he went on his way.
My patient had Post Traumatic Stress Disorder (PTSD), a syndrome caused by “exposure to actual or threatened death, serious injury, or sexual violence.”
As it turns out, so do hundreds of thousands of other veterans.
Citing Dept. of Veterans Affairs statistics, the Los Angeles Times of 8/3/14 notes that 648,992 veterans carry a PTSD diagnosis, including 348,164 who served in Vietnam and 250,744 serving from 1990 to the present, including Iraq and Afghanistan.
Still, there has been considerable controversy about the true scope of this problem. Going back to the early 1980s, after Vietnam, Congress engaged in furious debate between those who felt the vast majority of veterans had successfully readjusted to civilian life and those who did not.
The debate led to a congressional mandate to investigate the scope of the problem so that veterans with post-war psychological problems would receive appropriate care for them.
Research, the National Vietnam Veterans Readjustment Study (NVVRS), concluded in 1983 that a majority of Vietnam vets readjusted to post-war life, but that a substantial minority, some 26 percent, did not. Moreover, among those with high levels of war exposure, near 40 percent, had evidence of PTSD and or other significant emotional problems.
All in all, that’s a resounding finding that war experience leads to high levels of emotional distress.
Follow-up research, just presented at the American Psychological Association, concludes that 11 percent of combat Vietnam vets still suffer from trauma-related problems some four decades later. In addition, Vietnam vets with PTSD had higher levels of other health problems. And 30 percent of the group had pervasive depression problems.
Need more evidence that war exposure causes substantial emotional problems? From 2001-09, the Army suicide rate increased by 150 percent. By 2013, the veteran suicide rate was 22 per day, leading the Secretary of Defense to label it an “epidemic.”
Surveying a different part of the elephant that is the Veterans Administration, the VA Claims Backlog Working Group concluded in March 2014, “there remain nearly 700,000 claims (for benefits) that are in the processing phase…” and 400,000 “have been pending more than 125 days.”
Least you believe this is a new problem, Director David Baine of the VA Federal Health Care Delivery Issues Office wrote in 1994 that, “The Dept. of Veterans Affairs has recognized slow claims processing, and poor customer service as critical concerns. Claims processing times are increasing as are claims backlogs.”
Subsequent reports from the Government Accountability Office (GAO) have all concluded that the problems have gotten worse.
A Washington Post article of 4/5/14 commented on a shortage of mental health personnel in the military. But in 2007, the Mental Health Advisory Team IV noted that military mental health providers were frequently either “inaccessible” or “inadequately trained.” The Rand Center for Mental Health Policy also noted that only slightly more than half of those who do receive treatment get even minimally adequate care.
Where lies accountability for the strikingly inadequate care for veterans who put their lives on the line for this country?
An aside which really isn’t: In 1969, I was working in a New York City teaching hospital in the Emergency Room. A veteran — with bilateral, below-the-knee amputations of both legs due to poorly controlled non-service connected diabetes — wheeled himself into the ER on a freezing cold winter night.
He had come to the ER on several prior nights. He had no permanent residence. Finding that his blood glucose levels were not dangerously high and that he had no other medical problems requiring emergency treatment, we wheeled him back onto the street. He never returned. I knew then what we did was wrong and I know it now.
At some level, we are all responsible, from medical personnel like me who fail to protest the lack of adequate care provided to veterans, to staff who accept, or worse, hide the relevant facts, to veterans organizations that don’t protest loudly enough.
Still, I tend to attribute greater responsibility for these matters to the powerful, for they grease the machinery that moves the Veterans Administration.
Perhaps our long-serving politicians in Washington can supply part of the answer. You might ask them about it during the upcoming round of fundraising prior to the November elections.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at email@example.com.