Friday, May 16, 2008

PTSD on the Cheap?

Christopher Lee reports today in the Washington Post (May 16, 2008; Page A02) on a VA official who urged fewer diagnoses of PTSD:

"A psychologist who helps lead the post-traumatic stress disorder program at a medical facility for veterans in Texas told staff members to refrain from diagnosing PTSD because so many veterans were seeking government disability payments for the condition." "Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out," Norma Perez wrote in a March 20 e-mail to mental-health specialists and social workers at the Department of Veterans Affairs' Olin E. Teague Veterans' Center in Temple, Tex. Instead, she recommended that they "consider a diagnosis of Adjustment Disorder."

VA staff members "really don't . . . have time to do the extensive testing that should be done to determine PTSD," Perez wrote.

Uhm ... I really don't get it ... if VA staffers don't have time to do the extensive testing required to determine PTSD --- then, who the heck should make time for this? To be or to do ... that is the question - applicable even to Veterans Affairs. Reports indicate that this is an isolated case concocted by this official in Texas but I wonder if this is more widespread in reality. The reason I'm wondering is I know somebody who was attacked in Gitmo, had a botched surgery which caused permanent nerve damage, and was medically discharged. This person took and passed the FS exam, joined State, served in one of our toughest posts, survived that, and was assessed by his subsequent supervisors in the next post as difficult. It's hard to see if this person had PTSD out of Gitmo, or out of the first FS assignment as he/she was never diagnosed with PTSD until after he/she was kicked back stateside by his/her superiors (I think the nicer word for this is "involuntary curtailment"). Symptoms of PTSD can include:

  • Hypervigilance and scanning
  • Elevated startle response
  • Blunted affect, psychic numbing
  • Aggressive, controlling behavior (a high degree of insistence on getting your way)
  • Interruption of memory and concentration
  • Depression
  • Generalized anxiety
  • Violent eruptions of rage
  • Substance abuse
  • Intrusive recall -- different from normal memory in that it brings with it stress and anxiety
  • Dissociative experiences, including dissociative flashbacks
  • Insomnia
  • Suicidal ideation
  • Survivor guilt

I worry that if supervisors are not schooled on how PTSD manifest among employees, we may have a lot of employees who would be deemed "difficult" eventually. And by highlighting PTSD for those who serve in the war zones only, we may be ignoring those who serve in other hardship assignments outside of Iraq and Afghanistan (70% of FS assignments are considered hardships). I fear that they would fall into the cracks or get lost in the shuffle.

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