I recently published an article — Diagnostic abuse of veterans and the dilemmas of health professional ethics — [based on reporting by Mark Benjamin and Michael de Yoanna in Salon] on Army pressures for mental health clinicians to not diagnose post traumatic stress disorder [PTSD] in returning soldiers. A group of approximately 130 psychologists and mental health professionals responded to my article by writing Michelle Obama and asking her to look into these charges. Here is their letter:
May 12, 2009
The White House
1600 Pennsylvania Avenue NW
Dear First Lady,
We are a group of mental health professionals who hope to reach you about an issue concerning the treatment of our veterans. We are grateful that you have taken an interest in the well-being of veterans and their families, recognizing the weight of responsibility and trauma they may carry during and after service to our country.
In writing we want to call your attention to a concern that official pressures may be interfering with returning soldiers receiving appropriate treatment. A recent series in Salon by Mark Benjamin and Michael de Yoanna (latest May 5, 2009), reports pressure placed on mental health professionals to under-diagnose Post Traumatic Stress Disorder (PTSD) in returning combat veterans regardless of the clinical reality. A number of our colleagues who work with veterans have relayed similar experiences of pressure to misdiagnose.
One consequence of this apparent misdiagnosis is that the men and women who served our country do not receive appropriate Veterans’ benefits when their diagnoses do not correctly attribute their emotional problems to their combat experiences. Instead, their problems are attributed either to less severe “anxiety disorders” or to preexisting “personality disorders.” In addition to potential loss of benefits to which combat veterans are due, misdiagnoses can result in inappropriate treatment and in the veteran being held responsible for part or all of the cost of treatment for conditions caused by combat experience.
As mental health professionals, we are deeply disturbed that pressure is being put upon colleagues to give incorrect diagnoses for reasons antithetical to the best interests of our patients. Those who suffer serious disorders in the service of our country deserve better. They deserve the best treatment available. We are also concerned that this pressure may undermine the ethical foundation upon which the mental health professions are based.
We have included an essay by Dr. Stephen Soldz, co-founder of the Coalition for an Ethical APA and Steering Committee Member of Psychologists for Social Responsibility, which we believe sheds important light on this subject.
We ask you to look into this matter and related issues concerning the mental health treatment of our soldiers and veterans. We are willing to assist you in any ways we can in this endeavor.
With respect and regards,
Alice Lowe Shaw, Ph.D.
President-Elect Section IX, Division 39
Psychoanalysis and Social Responsibility
Stephen Soldz, Ph.D.
Director, Center for Research, Evaluation and Program Development
Boston Graduate School of Psychoanalysis
Psychologists for Social Responsibility (PsySR), organizational endorsement
Thomas Rosbrow, Ph.D.
Psychoanalytic Institute of Northern California (PINC)
Marilyn S. Jacobs, Ph.D., ABPP
David Geffen School of Medicine at UCLA
Dept. of Psychiatry and Biobehavioral Sciences