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Rethinking PTSD
A recent New York Times article about a new study on post-traumatic stress disorder (PTSD) remarks that the study is “viewed by experts as authoritative.” This knocks the air out of the Vietnam veteran punching bag that stress disorders among our combatants in the Vietnam War were especially severe, long-lasting, and extraordinary. This canard is currently used to similarly undermine the U.S. war effort in Iraq -- a war often without clear-cut fronts and enemy.
Other qualified analysts have come to this conclusion before. The co-authors of One Nation Under Therapy said in a Washington Post column that the criteria used in earlier studies "has a low threshold for calling a collection of symptoms a 'mental disorder.' " Another critique by an expert on PTSD points out the "official publication of the American Psychological Association, American Psychologist, has now reached a startling conclusion concerning all who undergo severe trauma: An astounding 85 percent of people actually show surprising and significant resilience..." Another Washington Post headline, “Some Veterans Feel Lives Enlarged by Wartime Suffering,” points to another PTSD expert's observation that “the whole field, in the last four years, has shifted to a certain extent to focus on resilience, on human potential. [Studies of World War II veterans showed] ‘Yes, I've suffered…but I wouldn't have given up this experience for anything in the world….The things I experienced have made me a better man today.'” Other studies have found similar rates of PTSD in combat troops as compared to civilians experiencing severe stress in their lives, as well as among civilians experiencing terrorism attacks or among firemen. An August 17 New York Times headline says a “Study Finds Fewer Cases of Post-Traumatic Stress in Vietnam Veterans.” The study, which contains important details not covered the NYT's article, appears in the August 18 journal Science, from the American Association for the Advancement of Science. Contrary to the widely reported figure that a third of Vietnam veterans have developed PTSD, this more careful study reports an occurrence -- still serious -- of 18.7% having temporary symptoms and 9.1% having lasting symptoms 10+ years after the end of the war. At the same time, the study points out “the majority of the veterans with high and very high MHM (military historical measure: “probable severity of exposure to war-zone stressors) did not develop war related PTSD.” According to the New York Times article: “I'd like to think that this study would help settle the debate, and that both sides would see that this was good science,” said the report's lead author, Dr. Bruce Dohrenwend, a psychiatric researcher at Columbia University and the New York State Psychiatric Institute. “It's true we found a significant reduction in the lifetime prevalence of these disorders,” he said, “but on the other hand we also found that more than 9 percent had current pathology, which is a substantial number of people.” Richard McNally, a psychologist at Harvard who is skeptical of the earlier estimate, agreed, saying that the new study confirmed his and others' suspicions. “It knocks the 30 percent number out of the box,” he said. But, he added, the findings “should not be used as a justification for short-changing services that are needed to help veterans” of Iraq or Vietnam. The new report is a reanalysis of a landmark 1988 study in which researchers tracked down 1,200 Vietnam veterans around the country and interviewed them. The reanalysis of the data, plus additional investigations, are the result. Another finding in the study is a very low rate of compensation-seeking exaggeration. Another notable result in the study itself is that: "The trajectory for most veterans with war-related PTSD that causes substantial impairment is toward amelioration or complete remission. This tendency toward improvement is present even for (approximately) 10% of veterans who still had impairing current PTSD at follow-up; the impairment most of them showed by this time (10+ years after the end of the Vietnam war) was not severe. The functioning of the veterans who had developed war-related PTSD but who no longer met criteria for the disorder at follow-up differed little from that of veterans who did not develop war-related PTSD." Like all good studies, the conclusion calls for “investigations of other factors that may contribute to initial resilience and psychological adjustment after traumatic war experiences.” This is an important and worthwhile path of study for all of us. The traits of resilience are fundamental to our health and success, as individuals and as a nation. |
About Bruce Kesler
Bruce Kesler, Vietnam veteran, lives in Encinitas, CA, where he owns an employee benefits consulting and brokerage firm. He is a contributing writer for the Democracy Project
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