

     If a random group of people were asked about post traumatic stress disorder (PTSD) today, more than half would associate it with war and soldiers. At the beginning of the Iraq war, we saw countless airports filled with civilians welcoming returning service members from overseas deployments.  It was a homegrown support network created by Vietnam Veterans who wanted to welcome the troops home, giving a welcoming reception that they themselves never received.  Some of those civilians standing with those veterans can only imagine what a soldier had seen and done, in countries like Iraq and Afghanistan, for the United States. Others could relate by what was seen on television broadcasts as reports rolled in nonstop on the 24-hour news networks about improvised explosive device detonations, explosively formed projectiles, exploding mortar rounds, militia attacks and snipers killing our service members almost daily. Then, as the wars continued to grind away through the years, reports of war crimes committed by service members in combat theaters shocked the nation.  Back in the United States, a sharp increase of reports that discharged service members were committing heinous murders and other malicious crimes were making headlines on all the major news networks.  Whether PTSD was diagnosed or not people began to associate service members with PTSD assuming that they had been deployed.  The term, “over diagnosis” is really a catch all phrase to the many misconceptions and actual diagnosis of PTSD.  A study conducted by Richard Kulka, for the Veterans Administration in 1990, reported that 31% of veterans experienced PTSD at some point in their lives. A follow-up study found that “clinically significant impairment,” the level required for diagnosis, was found in only 11% of those veterans. (Kulka, 1990) The objective is to apprise the general public that the military medical community is deliberately over diagnosing active duty and veterans with Post Traumatic Stress Disorder and the reason it is permitted.

   PTSD is an emotional illness that that is classified as an anxiety disorder and usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience.  (Dunning, 2000) PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event and are sensitive to normal life experiences like shopping in a crowd or sitting in a dim lite movie theater with strangers.  When people have suffered a violent or horrifying experience, the trauma can follow them around for years — and that is called Post-Traumatic Stress Disorder. From soldiers to accident victims to rape survivors, tons of people have found themselves haunted by their terrible experiences. PTSD didn't enter our vocabulary until 1980, when it was added to the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Society. There were probably many different terms used since the beginning of man on earth.  Untranslatable words to reference coward, scared or useless.   Today we know many historical terms for the condition. “The term "Soldier's Heart" was first used in the post-Civil War era when people were looking at those veterans returning from Civil War combat and trying to understand why they had been changed, because there was general recognition that they had been changed and many of those changes were not good.” Dating from World War I, "shell shock" is probably the most famous term for PTSD.  We now know that the soldiers staggering gate and generally unbalanced appearance was actually traumatic brain injury, basically, the brains were damaged from the constant bombardment of artillery shells the caused hypersonic and overpressure damage.  By December 1914, up to 10 percent of officers were suffering from shell shock, and 40 percent of casualties from the Battle of the Somme were shell-shocked. PTSD was being called combat exhaustion during World War II and the Korean War. People also called it "combat fatigue."  (Medina, 2015) These are some of the documented terms used to describe todays PTSD.

     PTSD, particularly among veterans, involves rocketing into extreme states of stress in the form of terror, rage, and uncontrollable impulses and plunging into equally extreme states of being shut-down like exhaustion, emotional numbing, despair, and dissociation. From this vantage point, PTSD clearly is about much more than fear and anxiety, involving the full range of emotions and undermining our body’s health, our ability to think clearly, to set and achieve goals, and to fully participate in and benefit from relationships.  

   Although this condition has likely existed since human beings have endured trauma, PTSD has only been recognized as a formal diagnosis since 1980. Virtually any trauma, defined as an event that is life-threatening or that severely compromises the physical or emotional well-being of an individual or causes intense fear, may cause PTSD. Such events often include either experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the victim of kidnapping or torture, exposure to war combat or to a natural disaster, exposure to other disaster (for example, plane crash) or terrorist attack, being the victim of rape, mugging, robbery, or assault, enduring physical, sexual, emotional, or other forms of abuse, as well as involvement in civil conflict.  (Dobbs, 2015) Although the diagnosis of PTSD currently requires that the sufferer has a history of experiencing a traumatic event as defined here, people may develop PTSD in reaction to events that may not qualify as traumatic but can be devastating life events like divorce or unemployment. Some symptoms such as depression and anxiety could be caused by a traumatic event but they could also be inherited. Military medical psychiatrists are not separating the few who really have PTSD from those who are experiencing things like depression or anxiety or social and reintegration problems, or who are just taking some time getting over it,” (Barglow, 2015) The American Psychiatric Association has clear criteria for diagnosing PTSD.  First, the patient has to have been through some type of trauma. This includes being directly traumatized, witnessing a terrible event, learning that something awful happened to a close friend or loved one, or repeated exposure as might happen for a first responder or soldier on the front lines. The patient must show certain types of symptoms that intrude into daily life, such as nightmares or flashbacks and finally people have to have had this cluster of symptoms for at least a month and it has to cause clinical distress (depression, anxiety) and functional impairment. Statistics regarding this illness indicate that a low percentage of people in the United States will likely develop PTSD in their lifetime. Combat veterans and rape victims have a lifetime prevalence of PTSD. Somewhat higher rates of this disorder have been found to occur in African Americans, Hispanics, and Native Americans compared to Caucasians in the United States. Some of those differences are thought to be due to higher rates of dissociation before and after the traumatic event (peritraumatic), a tendency for individuals from minority ethnic groups to blame themselves, have less social support, and an increased exposure to racism for those ethnic groups, as well as differences between how ethnic groups may express distress. In military populations, many of the differences have been found to be the result of increased exposure to combat at younger ages for minority groups. (Renaldo, 2014) Other important facts about PTSD include the estimate that 8 million people suffer from PTSD at any one time in the United States and the fact that women are twice as likely as men to develop PTSD. Treatment: Treatments for PTSD usually include psychological and medical interventions. Providing information about the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms of PTSD, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness. Education of PTSD sufferers usually involves teaching individuals about what PTSD is, how many others suffer from the same illness, that it is caused by extraordinary stress rather than personal weakness, how it is treated, and what to expect in treatment. This education thereby increases the likelihood that inaccurate ideas the person may have about the illness are dispelled, and any shame they may feel about having it is minimized. This may be particularly important in populations like military personnel that may feel particularly stigmatized by the idea of seeing a mental-health professional and therefore avoid doing so.  

     Despite well-documented mental health problems for a small subset of veterans, the majority appear to be doing well on most indicators of work and family quality of life despite their war-time experiences," explained corresponding author Dawne S. Vogt, PhD, associate professor of psychiatry at Boston University School of Medicine and research psychologist in the Women's Health Sciences Division, National Center for PTSD at the VA Boston Healthcare System. "These findings speak to the resilience of our service members, a topic that has received too little attention in the broader national conversation about veteran readjustment."  (Vogt, 2016) Now after all this information one can assume that the PTSD diagnosis was relegated to just war time experiences but in fact the military has many different situations that a service member can claim PTSD and receive financial compensation through the veteran’s administration.  

     Acts of terrorism, sudden traumatic events or disaster can lead to injury, death, and psychological distress. Veterans, like other people, respond to traumatic events in a number of ways. They may feel concern, anger, fear, or helplessness. These are all typical responses to a violent, malicious, or traumatic event. However, research shows that people who have been through trauma, loss, or hardship in the past may be even more likely than others to be affected by new, potentially traumatic events. Research has looked at how Veterans react to terrorism. While some studies report that Veterans react similarly to civilians when acts of mass violence occur, other studies report that their negative reactions may last for a longer length of time than civilians. During the attacks on September 11, 2001, the Pentagon was hit on the US Army side by a hijacked aircraft.  Service members from all branches may not have seen the impact but they experienced the aftermath of the rescue, the fire and the shock of the attack as the realization of the size and implications took hold.  

     Military sexual trauma, or MST, is the term used by the Department of Veterans Affairs to refer to experiences of sexual assault or repeated, threatening sexual harassment that a Veteran experienced during his or her military service.

The definition used by the VA comes from Federal law (Title 38 U.S. Code 1720D) and is "psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training."   I spent 23 years in the military serving in the Ranger Regiment, Airborne Infantry and Stryker Infantry Units, all male soldiers, so the first half of my career I was naïve to this even happening in the military.  Later as I started getting rank and responsibility there was a blunt realization that there were females that we had to interact with.  I am not talking about the female service members who had typical roles of doctors, physicians, psychiatrists, dentists and other roles that keep the Army functioning.  I am talking about the females who are on the battlefield and have a huge impact on the war.  Apache helicopter pilots who came to our rescue on more than one occasion, C130 Gunships who circled our positions at night making sure we wouldn’t be attacked unaware.  On the ground, we had female engineers who cleared road side bombs on a daily basis, they also drove ahead of us to identify improvised explosive devises before we rolled over them. Down on the ground, imbedded with my soldiers were female interpreters.  I found that the steady pace on our part in the war kept any improprieties at bay.  Most of the sexual allegations were in rear echelon, heavily fortified, main Army Camps.  With all the manpower, available they usually had 8-hour work days and then had 16 hours of boredom and mischief.  Now that I clarified that, sexual assault happens in the military community and it is disgusting.   The sad fact is that most of these assaults go unreported.  Another unfathomable fact is that it happens to males also.  This is another stigma that needs to be overcome so that those affected can get the proper PTSD treatment and those accused can be punished.  

     The symptoms or PTSD can be extremely distressing. Because they cause such a great amount of stress on the individual, many with PTSD will be unable to cope and turn to drugs or alcohol as a means of escape. As a result, 52 percent of males and 28 percent of females with PTSD meet the lifetime criteria for alcohol abuse or dependence. (Langdon, 2016)

      Endorphin withdrawal plays a part in the use of alcohol or drugs to control PTSD. When an individual experiences a traumatic event, his or her brain produces endorphins — neurotransmitters that reduce pain and create a sense of well-being — as a way of coping with the stress of the moment. When the event is over, the body experiences an endorphin withdrawal, which has some of the same symptoms as withdrawal from drugs or alcohol.

     If a PTSD diagnosis is given to the majority of soldiers who meet the criteria after returning from combat duty it seems that it would be beneficial to the soldier to receive treatment. However, it is expected for people to have nightmares for a while when they came back. But instead of allowing them to deal with these natural stressors, the Veterans Administration seemed to automatically view bad memories, nightmares and any other sign of distress as an indicator of PTSD.  The contradiction is when a service member is discharged and applies for compensation, the VA habitually downgrades the benefits or denies them all together.  Yet the two trends are consistent. The VA’s PTSD caseload has more than doubled since 2000, mostly because of newly diagnosed Vietnam veterans. The poor and erratic response to current soldiers and recent vets, with some being pulled quickly into PTSD treatments and others discouraged or denied, may be the panicked stumbling of an overloaded system.  One of the reasons that the PTSD claims are denied is because there were no follow ups from the service member after returning from combat to seek mental health care.  Why service members do not seek care is a matter of pride and the mission first attitude of their leaders.  First, no soldier wants to be known as the one who has numerous doctors’ appointments that interfere with training.  Soldiers are not given enough time to seek mental health care on their own without being called a malingerer.

     With the title of malingering a service member can be punished under the Uniform Code of Military Justice and removed from the military with bad conduct discharge.  Which prevents any benefits such as health or education to be used.  Military leaders frown upon so many medical appointments because of the missed training which is mandatory for future deployments.  While the leaders cannot deny service members the right to seek medical care, they can put pressure on junior leaders to encourage those soldiers to get back to training.  For those service members, whose pride forces them to continue training there will be no record of PTSD.  Therefore, the VA can easily deny benefits for those seeking treatment after leaving the service.  

     After the scandal of Madigan Army Hospital at Fort Lewis, Washington, where clinicians were urged to not to simply "rubber stamp" a soldier's PTSD diagnosis, which could allow the service member to retire with disability and lifetime health benefits ranging between $400,000 and $1.5 million.  Without a diagnosis, soldiers go without the proper care -- a combination of psychotherapy and medication -- and the financial benefits they need to be able to cope. 

   The Veterans Administration deliberately diagnoses veterans with PTSD and here are the reasons why it is appropriate.  A veteran with a rating for PTSD will be able to have access to mental health care free of charge for up to 5 years after discharge.  Because treatment takes time it is for the benefit of the veteran that they receive the PTSD diagnosis.  This will give the service member time to receive the treatment that is needed and be financially compensated.  After five years, the service member is reevaluated by VA doctors and continued compensation is based on if that service member continued treatment and success of those treatments.  The idea is that if service members who maintained a PTSD diagnosis only for financial gain will be reflected if treatment was not continued over those five years.  If not, then compensation would cease.  Over diagnosing should be continued for the benefit of the service members.  Using this method, it gives them a chance to seek treatment especially since PTSD symptoms can be delayed.  Once the operation tempo of active duty goes away, the veteran will have more time to dwell on those traumatic events and will hopefully seek treatment without the hindrance of negative peer pressure.
