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Specialists, patients critical of PTSD care

May. 23, 2007 - 10:30AM   |   Last Updated: May. 23, 2007 - 10:30AM  |  
Many factors complicate the treatment of Post Traumatic Stress Disorder, such as troops not willing to admit something is wrong for fear that it will damage their career.
Many factors complicate the treatment of Post Traumatic Stress Disorder, such as troops not willing to admit something is wrong for fear that it will damage their career. (Sgt. Tierney Nowland / AFP via Army)
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Experts told the House Veterans' Affairs Committee that reliable methods exist to immediately diagnose and treat post-traumatic stress disorder but they're not used.

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Experts told the House Veterans' Affairs Committee that reliable methods exist to immediately diagnose and treat post-traumatic stress disorder but they're not used.

At a May 16 hearing, the experts predicted a future filled with loneliness, health complications and societal breakdowns such as divorce, substance abuse or homelessness for veterans with PTSD if the nation does not address the issue now. And, they said, the long-term financial costs could be as much as $500 billion in health care for veterans with an illness that can be treated even cured for much less if dealt with immediately.

Even as the experts spoke, soldiers diagnosed with PTSD railed against their treatment during a simultaneous news conference at Fort Carson, Colo. They described undergoing the treatment methods the experts said should not be used, overwhelmed doctors and examples of how the stigma against PTSD persists in military culture.

Several factors complicate the issue: PTSD often does not show up until months or years after the battles have ended; troops sometimes don't mention mental health problems because they want to stay with their units while deployed or they fear it will kill their careers; those filling out health surveys in Iraq may avoid answering questions accurately because they just want to go home.

Moreover, proper diagnosis depends on a trained clinician, but often comes from a primary-care physician, which can cause problems because those with PTSD tend to have other mental health issues, such as depression, making treatment tricky. And if service members don't receive proper care within six months of developing symptoms, doctors have lost their best opportunity to cure them.

The experts said they have possible solutions.

"What's missing is the diagnostic piece ... standardized tests," said Saul Rosenberg, associate professor of medical psychology at the University of California.

And he's not talking about the surveys troops fill out to see if they might need to talk with a counselor. He recommended that every service member returning from a war zone take the Minnesota Multiphasic Personality Inventory, a test the Veterans Affairs Department already uses.

It's a self-test, and veterans home from combat could take it online. He recommended just-returning service members take it with a psychologist present to talk about the answers to questions such as, "I usually feel that life is worthwhile," or "Most of the time I wish I were dead."

Those are important questions, he said, because 5,000 veterans kill themselves every year. People with PTSD tend to try to numb their feelings with alcohol, which lessens impulse control and makes them more likely to follow through on suicidal thoughts.

"With that kind of procedure, I am absolutely confident we would save lives," Rosenberg said.

The way people think about mental health diagnoses also needs to change, he said, because mental health testing is as good for diagnosing mental problems as physical health testing is for physical problems.

There are also prescribed methods for treating PTSD. One recommended by experts and the VA is called Eye Movement, Desensitization and Reprocessing, based on talking through bad experiences to desensitize people to the pain associated with those memories.

"PTSD is very treatable ? people do get well," said Linda Rosenberg, president of the National Council for Community Behavioral Healthcare, who has no relation to Saul Rosenberg.

But the soldiers speaking from Fort Carson showed why getting help can be a problem.

Staffers from nine senators' offices interviewed nine soldiers the week of the hearing to hear about what problems they face following an investigation by Veterans for America. The Government Accountability Office is looking at alleged bad treatment of soldiers there who have PTSD or traumatic brain injuries.

Discharge offered

During the May 16 news conference, one soldier said he had been diagnosed with chronic PTSD, but had been offered a quick way out with a personality disorder discharge. But if he takes it, he loses his VA benefits and may never receive treatment for his disease.

The soldier said he only received half an hour of one-on-one counseling a month, and usually received group therapy.

"Group therapy is not the most effective way to treat PTSD," said Suzanne Best, a research psychologist in the Posttraumatic Stress Disorder Research Program at the VA Medical Center in San Francisco. "It would be difficult to treat anyone in half an hour or less. If someone says they can, they are not clinicians who treat PTSD."

Best participated in the telephone conference at Fort Carson.

Steve Robinson, legislative liaison for Veterans for America, said only one clinician at Fort Carson is trained in EMDR, but doesn't have time to use it because he has so many patients.

The panelists recommended allowing troops to seek private care if a military or VA hospital doesn't have time for them, or if they fear problems with their command, and called for bringing family members into counseling with the veterans.

And they also recommended educating society and military leadership about PTSD as a normal reaction to the death and destruction service members witness not as a disorder claimed by people who "can't handle" war or who are trying to get over on the system.

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