This is an article that speaks of the Department of Veteran's Affairs failure to treat PTSD.
The point of this Op Ed is to illustrate significant flaws in the system that is set up to treat our veterans. If we continuously operate with a longstanding maladaptive treatment system for our veterans we might want to ask ourselves as a nation what their sacrifice was worth to this nation. We may want to ask ourselves whether we can do better on their behalf.
The Politics of Post Traumatic Stress Disorder (PTSD) treatment is a moral atrocity at the Department of Veteran's Affairs and in military medicine. There is a national discussion between veterans about the treatment of traumatized at the Department of Veteran's Affairs specialized trauma departments.
PTSD can be described as a set of symptoms that are normal reactions to abnormal and tragic stimuli such as war, natural disaster, or sexual assault. Another approach to defining PTSD is to define PTSD as a set of maladaptive traits that developed as a result of a trauma. The latter definition presents the traumatized veteran as flawed or defective. The conditions that cause PTSD are so horrific that referring to the person that suffers, as "Disordered" is a misnomer at best and victim blaming at worst.
Paula J. Caplan, in her book When Johnny and Jane Come Marching Home: How all of Us Can Help Veterans, alerts the American public to the fact that war is indeed horrific. Perhaps listening to veterans rather than labeling them is the most humane thing that America can do for those that served us.
The term "Disordered" is not the worst part of PTSD diagnosis and treatment. There is a politics that accompany PTSD diagnosis and treatment. Symptoms of PTSD can overlap with several other conditions such as "Bipolar II" and "Borderline Personality Disorder." According to a 2004 Article that was written by pioneer Military Sexual Trauma Advocate Susan Avila Smith:
These women are misdiagnosed and labeled as "psychotic," "drug-seeking," and "bipolar" or "borderline personality." Knowing this, I tell them that they are "normal" if they are experiencing such symptoms and that they need to file claims for these symptoms Secondary to their PTSD. They typically break down with relief that they are not alone, because they often have been led to believe that they are crazy or somehow "delusional" because they have failed to "get over it." (Smith 2004)
These diagnoses are used in the military to discharge people that report rapes. Knowledge of the manipulative use of a "Borderline" diagnosis is nothing new. The question is whether our veterans are important enough to the nation to do something about this atrocity. This writer thinks that they are.
Axis II psychotic diagnoses appear to be used by the Department of Veteran's Affairs to limit treatments to veterans that suffered trauma while in service and to keep the numbers in specialized trauma clinics low and therefore manageable. This can enable a research trauma clinic to report dynamic outcomes. Reported outcomes of "Evidence Based" therapy" are not convincing when veterans are killing themselves at a rate of 18-22 per day.
Composer, co-producer of Service, the documentary, and veteran advocate Patricia Lee Stotter coined the term "Weaponized Diagnosis." Weaponized diagnosis is when a psychiatrist or a psychologist diagnoses a condition, usually something they deem "pre-existing in order to remove a whistle-blower from active duty or deny a veteran treatment. Calling these people insane does more than deny them service and cover up assaults, they also kill careers and destroy families. It would be helpful to
know the number of the 18-22 veterans per day that were shown the door
by a VA doctor in bondage to a broken system.
A case of "Weaponized Diagnosis" might look like this: A veteran may check into a PTSD clinic and not immediately respond to the limited treatments that are available at that clinic. Rather than exert greater effort on behalf of the veteran the staff may give a Weaponized diagnosis of Borderline Personality Disorder and dismisses the patient from treatment. A trauma therapist might do this in order to claim a higher delta of patient success and secure greater funding only to continue to offer mediocre care.
In a November 25 2012 conversation with Harvard psychologist and author of When Johnny and Jane Come Marching Home: What all of us can do to help veterans, the following impression was shared.
"In my experience, many therapists use the Borderline diagnosis when they don't feel comfortable with or don't want to treat a client. It is not just what you might call generally inept therapists who do this. The severe label is in the DSM, and I have known therapists who were not aware that what was happening was that they assigned that label because of their own difficulty or dislike of dealing with a particular patient."
A therapist that "Just does not want to treat a veteran" is troubling. Equally troubling is that the now victimized veteran did not have that same choice in service. That veteran served every American in every walk of life. That veteran served everyone whether they liked their politics, their religion, or what kind of car they drove. That veteran never had a choice of whether to witness bloodshed, enemy fire, or military sexual trauma. That veteran suited up, showed up, and did their job. The person that delivers care to veterans has "Choices." Those "Choices may contribute to 18 to 22 suicides per day.
After a Borderline Personality Disorder diagnosis is a matter of record a veteran has no choice regarding their therapy. If they get therapy at all they get an overbooked therapist or the most junior therapist in the house. PTSD, poly-trauma, military sexual trauma, explosions, major fuel disasters, hostage situations, live sea battles with Somali Pirates, collateral damage explosions that cause nightmares for life should not be cavalierly dismissed from a trauma clinic after a veteran served without reservations.
A veteran's PTSD might have come from having saved lives during hurricane Katrina but with one swift stroke of a diagnostic pen that veteran might be forever branded "Untreatable." Veterans that served without reservation may be relegated to homelessness because Borderline Personality Disorder looks just like PTSD.
Any VA or Military Doctor that disliked the color, gender, sexual orientation, weight, religion, or politics of that veteran can ruin their lives with Weaponized diagnosis. Weaponized diagnoses can cost veterans custody of their children, jobs, security clearances, and benefits.
In an April 3, 2012 article for the Salem Times Dr. Phil Leveque made this comment about the numbers of "Psychotic" or "Borderline psychotic" diagnoses that were used to discharge infantry personnel.
"According to the VA, the Navy, since 2002, has discharged 7735 veterans with Personality Disorder (PD) instead of PTSD. How they recruited so many sociopaths is impossible to believe. For the Air Force, in 2006 they committed vicious slander with PD discharges to 1114 of 29,000 service members a rate of 3.7%. How did they recruit so many sociopaths??" (Leveque 2012)
Dr Leveque appears to have been speaking on the matter of "Weaponized Diagnosis" before the term was coined.
In February of 2012, Dr. Leveque said this in an article on the problem of Personality Disorder diagnoses:
"It requires a bit of witchcraft and sorcery to define Personality Disorder or to diagnose that in the troubled person. A recruit goes through several medical-type exams before he/she actually gets into the service. If that person is the slightest bit "flakey" they won't even get in. Basic Training is a real "Ball Buster" and if any recruit doesn't seem to have some of the order taking gung ho personality to be a real soldier or marine he/she will NEVER get through that training. Even after that they are still under surveillance and can "flunk out" any time." (Leveque 2012)
A note on the DOD and VA official policy on Axis II personality disorders, as the DOD and Department of Veteran's Affairs understand them. This is taken from the VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress: (Page 84)
Personality Disorders: Personality disorders are long-term problems of coping that begin in childhood or adolescence and are often associated with past abuse or neglect and recurrent relationship problems. These patterns often result in poor adherence to prescribed PTSD management, and the primary care provider may require early assistance and advice from the mental healthcare provider.
A primary care provider should remain cautious of a personality disorder diagnosis when PTSD is a known or suspected diagnosis. In some instanced PTSD can be attributed to a Personality Disorder. A mistaken personality disorder diagnosis can lead to delays in treatment for PTSD. Poor adherence to treatment can indicate a personality disorder but it also may indicate a patient that was sexually assaulted on active duty and the assault was not appropriately investigated by the chain of command. (End)
A Personality Disorder Diagnosis is a prima fascia anathema to effective treatment. They are often given too early, with too little evidence, and with overlapping data for a PTSD diagnosis. If a veteran or service member is given a Borderline or other Axis II diagnosis there is a nexus for a trauma they should find out where that doctor is licensed and file an ethics complaint. They should also complain all the way up that doctor's chain of command. That veteran should contact their Congressional Representative and ask for an investigation on the clinic that gave the diagnosis. The next abused veteran may kill them selves and that veteran deserves the gift of life after service and they deserve fulfillment after trauma.
Stay tuned for more on how to help veterans survive mistreatment at the Department of Veterans Affairs.We are greater than what happened to us.
Jennifer McClendon is a US Navy veteran, a teacher, an historian, and a social issues writer. She believes that if given the chance people will ultimately do the right thing.