Patriot: At Any Cost

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P TSD wasn't recognized as a distinct syndrome until the s. Before then psychologists believed that only weak men, those with hereditary or genetic flaws, suffered from combat stress. War was seen as a kind of crucible of masculinity that made strong men stronger.

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Still, by the early s, more than half the patients in American VA hospitals were in psychiatric wards. The remedy for weakness was harsh: During World War I and World War II stressed-out Soldiers were given heavy courses of electroshock until, as one historian puts it, "the horror of the therapy was greater than the horror of the front.

Medical opinions began to change in the s with what was then called post-Vietnam syndrome, a condition marked by rage at being "duped and manipulated by society. Rather than blame the character of the Soldier, doctors blamed the war itself. For all but a small group of conservative thinkers, PTSD has outgrown its early links to the antiwar movement to become an objective psychiatric category, as above the fray of politics as anxiety or depression.

Still, an influential group of culture warriors and military commanders believes PTSD was an invention of liberals seeking to justify their politics with science. With the election of George W. Bush, these fairly radical views were suddenly given a much more receptive hearing. Burkett, a retired Texas stockbroker, has spent the past 20 years waging a one-man crusade against deceitful American Soldiers. If it were up to him, we'd have no war at all! I watched my mother die. It wasn't easy, but I'm still here. Whatever happened to resilience as a virtue?

Burkett cheerfully and forcibly presents the notion that PTSD has become a scam used by antiwar liberals and that thousands of Vietnam Veterans are faking illnesses in order to cash in on federal disability payments. Burkett co-authored the book Stolen Valor for which he received a thank-you note from Bush , which documents several cases of brazen fraud perpetrated by Vietnam Veterans. Considering that this anti-PTSD movement represents a minority position well outside mainstream psychiatry, it has achieved impressive gains in the past few years.

Another spokesperson for the movement, Dr. Sally Satel, a psychiatrist and an advisor to President Bush on mental health issues, argues that mainstream psychiatry is pathologizing everyday life, turning normal states of consciousness into medical problems in a kind of therapy creep. Satel's name may sound familiar, as she is frequently published in the popular press and has offered expert testimony on PTSD even though she has not authored any noteworthy peer-reviewed papers on the disease.

I'm not saying PTSD doesn't exist, but it's gotten out of hand. I mean, if you see a lot of action and then when you come home you have a hard time walking the dog by the bushes at night, maybe you just avoid the bushes.

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Does that entitle you to a lifetime of payments? And I don't think those payments even help you get well. They love her for it. Whether because of pressure from the anti-PTSD group or under his own philosophical steam, William Winkenwerder, the assistant secretary of defense for health affairs, who is responsible for the health and well-being of all troops, in early had already formulated a new protocol for dealing with PTSD.

Essentially this new tack held that when handling returning troops, it was medically appropriate not to diagnose PTSD. Instead, troops with PTSD symptoms would not be told of the suspected diagnosis but would be closely monitored to see if their symptoms worsened or improved. In a letter to the General Accounting Office, Winkenwerder, the highest-ranking official with day-to-day control of mental health policy, called this new approach watchful waiting.

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The familiar term watchful waiting derives from the language of cancer treatment but is usually a course of therapy undertaken with the full consent of a patient after a diagnosis has been made. Watchful waiting, which sounds to some like "don't treat, don't tell," is not part of the accepted psychiatric treatment protocol for PTSD, nor is the term mentioned in the military's own field handbook for in-theater doctors treating trauma cases.

I contact Paula Schnurr, the editor of that handbook and a nationally recognized PTSD expert at Dartmouth, and ask if watchful waiting has an entry. There is a long pause on the other end of the line.

Well, I guess it's not in here. If someone presents with the symptoms, you give them the diagnosis. I find, in fact, in a lot of cases it is a relief to know the name.

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They're not stigmatized by it. They're relieved to know they're not crazy. Scurfield is slightly less diplomatic about this administration's offhand approach to Soldiers' mental illness. Actually the statistics suggest Iraq is a lot scarier than Vietnam. The likelihood of a Soldier having to face live fire is higher than in any previous American war. Some 77 percent have pulled the trigger in an attempt to kill, which is roughly three times the trigger rate of World War II; 95 percent have seen dead bodies, and 89 percent reported having been ambushed or attacked.

The urban warfare in Iraq has no clearly delineated front and no safe zone in the rear where Soldiers can go to decompress. The insurgency is spread across the country and moves freely through the same areas American troops have to traverse just to get around. No place, not even a guarded base, is safe, and the conflict has become the ultimate petri dish for PTSD. By late military doctors working closely with troops had finally recognized the growing problem of PTSD among the ranks.

Determined to stem the tide, even at the risk of displeasing the politically appointed higher-ups in the military, they pressured the DOD to return combat-stress teams to Iraq. In December that duty fell to the 55th Medical Company, an person-strong unit that was "tasked," in military speak, with providing psychological care for the entire in-country force, roughly , troops.

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The patient-caregiver ratio was 1, to one. Since then the Army has increased combat-stress personnel in Iraq to The deputy commander for clinical services of the 55th was Lieutenant Colonel Kathy Platoni, one of the Army's top field psychologists and a hyperkinetic year-old with a blunt, assertive manner that does not fit the mold of the ivory-tower academic.

Platoni spent the better part of two years traveling around Iraq. She found that underneath the bustle and swagger of life on a military base was a lot of unspoken pain and psychological suffering. I was seeing people who were dealing with a tremendous amount of combat stress and seeing their buddies just burned to death, incinerated or blown to smithereens. People will be jittery, shaky; they will cry. They can't sleep; they can't eat.

They drop into a rage very quickly. They try to hide it, but you can see the signs.

Adding to the strain are the tight restrictions on American Soldiers on Iraq bases -- no alcohol, no porn allowed. Platoni concluded PTSD was rife among the troops she saw, running at a rate of between 15 and 20 percent. But she could do little to help. Her contact with Soldiers in the field amounted to barely more than brief hellos between mortar attacks.

We're force multipliers. Very few people get evacuated out of theater because there are so many shortfalls with people getting killed or injured. So there's that implicit message that you don't want to take anybody out of the action. Home now in Ohio, with just a few years left on her Army Reserves contract, she finds that on the short drive to her office she often scans the country roads for improvised explosive devices. When she goes out to dinner she always sits facing the door.

She startles easily at loud noises.

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She says her thoughts always return to the Soldiers she saw in the field. I don't think we have a good way to resolve that. We just don't. T he government's attitude seems to be having the desired effect of keeping PTSD patients out of the DOD health care system and transferring the caseload burden to Veterans Affairs when the Soldiers return home. Since the wars in Iraq and Afghanistan started, , people have been discharged from the military, including National Guard and Reserve Soldiers who are now deactivated.

Of those, 73, have sought mental health treatment at the VA. A rumor going around the Veterans community claims that, even in cases of existing injuries, military doctors are underdiagnosing PTSD at military hospitals, preferring instead to use labels that do not entitle the Soldier to combat-related compensation. Military doctors "are being told not to diagnose PTSD. The head of the agency, Anthony Principi, a longtime favorite of Veterans groups, resigned.

The timing of his resignation was suspect, as it came shortly after he told Congress the agency lacked funds to take care of Veterans, and the move was widely interpreted as a firing. Bush replaced Principi with a high-level party operative named James Nicholson. A Republican power broker and a party heavyweight, he chaired the Republican National Committee during the presidential campaign, when he called Dick Cheney "one of the most qualified, beloved people in America.

First, in a move that echoed Burkett's charges, Nicholson ordered an investigation into the files of 72, Veterans who had received PTSD compensation. Senate Democrats managed to undercut the review.

That too fizzled. Finally, a second study was commissioned to "assess how PTSD compensation might influence beneficiaries' attitudes and behaviors in ways that might serve as barriers to recovery.