Posts Tagged ‘PTSD’

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The following article entitled “Honor, Stigma…and PTSD” is written by Frank Ochberg who is the Co-Chair of SFTT’s Medical Task Force.   Dr. Ochberg has been dealing with the complexities of PTSD for some 40 years.   His words resonate even more strongly today as many troubled veterans are returning home to environments which may appear to be less hostile on the surface, but are equally dangerous nonetheless.  Our institutions are simply unprepared and, perhaps, unwilling to deal with the complexities of PTSD and, as such, we run the risk of losing an entire generation of brave warriors to the stigma and horrors of PTSD: the “signature wound” of our wars in Iraq and Afghanistan.  Join SFTT and help get these brave warriors the treatment they deserve.

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I’m an old guy from the Vietnam era, a psychiatrist who studied violence in the 1960s, who treated survivors of trauma in the ’70s and who helped create and nurture the concept of post-traumatic stress disorder through the ’80s.

There are a few dozen of us who are considered the pioneers of the modern era of traumatic-stress studies, and most of us are worried – deeply worried — on behalf of the current generation of veterans with invisible wounds.

We thought that by now there would be access to care whenever needed. We thought that by now there would be clear understanding that PTSD is a wound, not a weakness. We thought that a veteran who served honorably and received a compensable medical diagnosis for PTSD due to his or her service on the field of battle, would receive a medal for sacrifice.

But instead of honor, there is stigma. And this stigma must stop.

Stigma is an elusive concept. It means we mark a person or a whole caste of people for exclusion. Stigma may mean we mark ourselves as diminished, degraded and unsuited for inclusion and intimacy. Stigma is insidious, communicated in whispers, in gossip, and in gestures without words.

Why in the world, this enlightened world, would we stigmatize our veterans who come home with PTSD, or traumatic brain injury, or depression?

Perhaps we do it out of ignorance or fear or extrapolation from the few, atypical cases of domestic and criminal violence that grab headlines. When job opportunities are limited due to diagnostic labels, it is reasonable to avoid the label.

(MORE: Troop Mental Ills: Psychiatric or Organic?)

When advancement through the ranks is limited by labels, it is reasonable to reject diagnosis and treatment. So fearing the consequences to livelihood, some suffer in silence and, in a way, add to the climate of stigma.

There are now a growing number of us who have joined a campaign to change this climate of stigma. We cannot wait for the rate of suicide among young veterans to recede of its own accord. We cannot wait for the VA to catch up with its caseload of cases –veterans waiting months for an appointment. We want to change labels, to improve media coverage, to improve awareness, to emulate successful campaigns to reduce stigma, and to honor our veterans who bear invisible wounds.

Here are some activities we commend:

  • Support the request of former Vice-Chief of Staff of the Army, General (ret.) Peter Chiarelli to change the title PTSD to PTSI – for Injury. Anyone can endorse this campaign right here. But time is limited. It must be done by June 10 to be considered by those with the power to make the change. All the arguments for doing this are on the site.
  • Visit the Dart Center’s website, particularly if you are a journalist covering this topic. Reporters can do a better job covering trauma, war and PTSD. There are tools of the trade to improve accurate and sensitive reporting of those topics. Bloggers can benefit, too. Telling the true story of PTSD will reduce the stigma of PTSD.  (MORE: A Lone Madman or a Broken System?)
  • Attend National PTSD Awareness Day, June 27, on the Senate grounds of the U.S. Capitol. Sponsored by the veterans’ group, Honor For All, this gathering will honor all who have served and sacrificed, including those who took their own lives, struggling with “invisible wounds of war.”
  • Sign the petition calling on our president to establish a Presidential Advisory Committee to reduce the stigma of PTSD and related invisible injuries, earned in service to our country. This committee could tap leaders in all walks of American life, entertainment figures, professional athletes, architects of the successful campaigns on behalf of breast cancer. If football players can wear pink gloves to support breast cancer awareness, baseball players can swing purple bats on PTSD Awareness Day.

We will not defeat the stigma of PTSD easily. No single idea, petition, campaign or organization can turn public attitude around. Changing PTSD to PTSI is a significant step on the road to honor, away from stigma. The word, injury, is honorable in military culture and accurate in medical parlance. Let’s start there and move forward together.

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Frank M. Ochberg, M.D., is the medical adviser of Honor For All, Co-Chair of Stand For The Troops Medical Task Force, having served in uniform during the Vietnam era. While Associate Director of the National Institute of Mental Health, he helped define PTSD, then edited the first text on its treatment. At Michigan State University, he is clinical professor of psychiatry, formerly adjunct professor of criminal justice, and adjunct professor of journalism.

 

 

 

In a heart-breaking story by Mike Scotti entitle ” below:

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THE Department of Veterans Affairs, already under enormous strain from the aging of the Vietnam generation, the end of the Iraq war and the continuing return of combat troops from Afghanistan, announced in April that it would increase its mental health staff by about 10 percent. But too many veterans waging a lonely and emotional struggle to resume a normal life continue to find the agency a source of disappointment rather than healing.

The new hiring is intended to address the infuriating delay veterans face in getting appointments. The V.A. says it tries to complete full mental health evaluations within 14 days of an initial screening. But a review by the department’s inspector general found that schedulers were entering misleading information into their computer system. They were recording the next available appointment date as the patient’s desired appointment date. As a result, a veteran who might have had to wait weeks for an appointment would appear in the computer system as having been seen “without a wait.” That allowed the agency to claim that the two-week target was being reached in 95 percent of cases, when the real rate was 49 percent. The rest waited an average of 50 days.

As a veteran of both Iraq and Afghanistan, I found that news maddening. While the schedulers played games with the numbers, veterans were dealing with mental wounds so serious that getting proper attention at the right time might have made the difference between life and death. Even worse was that the V.A. had failed twice before to change; the inspector general found similar problems in 2005 and in 2007. This suggests a systematic misrepresentation of data and an unwillingness to stop it.

Unfortunately, the problem goes even deeper. There are potentially hundreds of thousands of veterans who are struggling with post-combat mental health issues who never ask the V.A. for help. Some, hamstrung by fear of stigma, are too proud or too ashamed to ask for help. Others don’t ask because they’ve heard too many stories from peers who have received poor care or been ignored.

I have close friends who could no longer drive because of their lingering fears of roadside bombs. Others had gone to the V.A. because they had suicidal thoughts, only to receive a preliminary screening, a pat on the back, a prescription for antidepressants — and a follow-up appointment for several months later.

I’ve had my own struggle: in 2001 I was part of the initial force of Marines who landed in Afghanistan, and in 2003 took part in the heavy fighting of the first wave of the invasion of Iraq. Since coming home, I’ve had my mind hijacked by visions of the corpses of children, their eyes blackened, at the side of the road. I recall carrying the coffins of fallen brothers. I remember losing friends who probably knew exactly what was happening to them, as they bled out on the side of a dusty road in Iraq.

And I’ve felt the shame of having suicidal feelings. Like many others, I chose to hide them. Yet, even in the darkest days of my own post-traumatic stress, when I was considering choosing between making my suicide look like an accident or taking a swan dive off some beautiful bridge, I never considered going to the V.A. for help.

My image of the V.A., formed while I was on active duty, was of an ineffective, uncaring institution. Tales circulated among my fellow Marines of its institutional indifference, and those impressions were confirmed when I left Iraq for home. At Camp Pendleton, Calif., a woman with a cold, unfeeling manner assembled us for a PowerPoint presentation and pointed us to brochures — nothing more, no welcoming sign of warmth or empathy for the jumble of emotions we were feeling. Her remoteness spoke volumes to me of what I might expect at home.

To regain veterans’ trust, the V.A. must change its organization and culture, not just hire more people. First, its leadership must be held accountable for employees’ behavior, and anyone caught entering misleading data should be fired. The agency must reach out, with public awareness campaigns and with warmth, to veterans who may be suffering in silence. It must help reduce the social stigma that attaches to the mental health issues the veterans face.

Dedicated V.A. personnel run a suicide-prevention hot line, but it is only a temporary salve for emergencies. One impressive and highly effective alternative to the V.A.’s traditional treatment process is the Wounded Warrior Project’s Combat Stress Recovery Program, which emphasizes the importance of interpersonal relationships, goal-setting and outdoor, rehabilitative retreats and seeks to avoid the stigma associated with traditional treatment.

What this generation of veterans needs from the V.A. is a recognition that when the color of life has faded to gray, you need to talk to someone about it today, not weeks or months from now. We need America to acknowledge what war does to the young men and women who fight it and to share the message that dragged me out of the darkness: It’s O.K. if you’re not O.K.

Mike Scotti, a former Marine, is the author of “The Blue Cascade: A Memoir of Life After War.”

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We hear you Mike.   Our thoughts – and action – are with you and the thousands of brave heroes who deserve proper treatment from the V.A.

In an editorial opinion published in the New York Times on May 26th entitled ”

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The Departments of Defense and Veterans Affairs have repeatedly promised to do a better job of handling the medical evaluations of wounded and disabled service members. Instead, they are doing worse.

The processing of disability cases is getting slower, not faster. Efforts to ensure a “seamless transition” out of the military are falling short. Men and women are languishing without treatment, struggling to readjust to civilian lives as they cope with post-traumatic stress disorder, brain injuries, drug addiction and other service-related afflictions. The system that should be producing reliable results is mired in delays and dissatisfaction.

A new report by the Government Accountability Office lays out the problem. In 2007, the two departments began combining their separate, complicated and cumbersome processes for disability evaluations into one system. The system is now in place worldwide, and officials from both departments promised the Senate Veterans’ Affairs Committee a year ago that it had become “more transparent, consistent and expeditious.”

But the accountability office found otherwise. It said processing times for disability cases had actually gone up — to an average of 394 days for active-duty troops and 420 days for National Guard members and reservists in 2011, well over the departments’ goals of 295 and 305 days. In fiscal year 2010, 32 percent of active-duty troops and 37 percent of Guard and Reserve troops completed evaluations and received benefits within established timelines. Last year, those figures fell to a dismal 19 percent and 18 percent.

What’s going on? The report says the causes are not fully understood, but it points to persistent staffing shortages, problems in collecting and reporting data, and differences among the service branches and between the Pentagon and the Veterans Affairs Department in the way cases are diagnosed and tracked. The accountability office says it will make recommendations later this year as it sees whether promised improvements are taking hold, including a hiring push by the Army — a huge source of processing bottlenecks — and the V.A.

Senator Patty Murray, chairman of the Veterans’ Affairs Committee, deserves credit for focusing attention on these and other failings in a series of hearings, including one last Wednesday that examined the bureaucratic delays. She also used the hearing to bring up disturbing reports that doctors at an Army base in Washington State had repeatedly — and wrongly — rejected soldiers’ legitimate post-traumatic stress disorder claims.

Wounded and disabled service members should not be forced to wait endlessly without treatment or benefits while the government evaluates their injuries. Nor should they have to battle their own government for honest treatment. The evaluations should be accurate, not consistently wrong. Ms. Murray noted on Wednesday that there were about 27,000 military personnel in the system, three times the number in 2010. Many more are on the way. “Clearly, much work remains to be done,” she said. She is right. There is no excuse for more backsliding and delay.

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Enough “lip service” as Hack would say.  Let’s rollup our sleeves and help these brave heroes.

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