What motive does the Army have to misdiagnose PTSD?

So asks the two Salon writers, Mark Benjamin and Michael de Yoanna, following their recent series starting with the incriminating evidence, an audio recording by a Veteran suffering from PTS. Recording his visit because his wife couldn't be there so he needed a way to remember what took place in his session with his army psychologist.

A reluctance to diagnose post-traumatic stress disorder could be about the money, and about the need for troops in Iraq and Afghanistan.

The subject title and the blockquote above are what they use in their forth of four reports from last week. That all started with this audio from a session with Sgt. X and his army psychologist:

April 10, 2009 | In two stories published this week, Salon has described how a soldier secretly taped a psychologist saying that the Army was exerting pressure not to diagnose soldiers with post-traumatic stress disorder. Psychologist Douglas McNinch of Fort Carson, Colo., twice states on the recording that the Army discourages PTSD diagnoses.

If what McNinch says on the tape is true, why is it happening? Why would the Army purposely diagnose soldiers suffering from post-traumatic stress disorder with something other than PTSD? Combat stress is as real as your big toe. Why would the Army want to deny, or at least minimize, a known consequence of combat? The truth might rest in math.

This is their first report:

"I am under a lot of pressure to not diagnose PTSD"

A secret recording reveals the Army may be pushing its medical staff not to diagnose post-traumatic stress disorder. The Army and Senate have ignored the implications.

Editor's note: Last June, during a medical appointment, a patient named "Sgt. X" recorded an Army psychologist at Fort Carson, Colo., saying that he was under pressure not to diagnose combat veterans with post-traumatic stress disorder.

April 8, 2009 | FORT CARSON, Colo. -- "Sgt. X" is built like the Bradley Fighting Vehicle he rode in while in Iraq. He's as bulky, brawny and seemingly impervious as a tank.

In an interview in the high-rise offices of his Denver attorneys, however, symptoms of the damaged brain inside that tough exterior begin to appear. Sgt. X's eyes go suddenly blank, shifting to refocus oddly on a wall. He pauses mid-sentence, struggling for simple words. His hands occasionally tremble and spasm.

The Audio with above initial report is the one above or at that site page.

The next day Mark Benjamin and Michael de Yoanna wrote a follow up article:

Tale of the secret Army tape

After a soldier taped a psychologist saying he'd been pressured not to diagnose PTSD, the Army launched an investigation. Read the details of how the Army declared itself innocent.

Editor's note: Read about Sgt. X's tape -- and listen to a segment of it -- in the first story in this series, "I Am Under a Lot of Pressure to Not Diagnose PTSD." Read a summary of the Army's internal investigation, in which it determined that it was not exerting such pressure, here

"This report does not find pressure to change clinical diagnoses"
A summary of an Army investigation says some soldiers with PTSD may not get the diagnoses they deserve -- but nobody in the Army did anything wrong.

April 9, 2009 | In a story published yesterday, Salon reported on a surreptitious tape recording of an Army psychologist telling a patient last June that he had been pressured not to diagnose soldiers as having post-traumatic stress disorder. The soldier, whom Salon dubbed Sgt. X to protect his identity, recorded the Fort Carson, Colo., psychologist, Douglas McNinch, twice describing pressure to label soldiers with "anxiety disorder" instead of PTSD. The diagnosis of anxiety disorder could result in improper treatment and lower disability payments if the Army discharges a soldier from the military. "It's not fair," McNinch said on the tape. "I think it's a horrible way to treat soldiers."

That night, the 9th, on MSNBC HardBall they had this discussion:



Now to just break in, on the Salon reports, here this was known about, or at least suspected, from reports many of us Veterans or Advocates of had been hearing about or in talking to the returning soldiers from these two theaters. But on May 15th 2008 VoteVets and CREW {Citizens for Responsibility and Ethics in Washington} broke it open with a press release:

15 May 2008 // Washington, DC – Today, Citizens for Responsibility and Ethics in Washington (CREW) and VoteVets.org released an e-mail obtained from a Veterans Affairs (VA) employee directing VA staff to refrain from diagnosing soldiers and veterans with Post Traumatic Stress Disorder (PTSD).

And in searching out a bit of information I came across this CNN Video from a month before:

Post traumatic stress stigma Sun, March 8, 2009
Army generals hope to remove the stigma that keeps many soldiers from getting help for stress. CNN's Barbara Starr reports.

These two Generals had recently come out about their own PTS and the counciling and help they received, and their want to help their fellow soldiers to seek out the help needed themselves.

On the day of the second Salon report there was another discussion at CNN:

Veterans and PTSD Thurs. April 9 2009
Veterans groups talk about post-traumatic stress disorder to CNN's Kyra Phillips
.

Now in the CNN discussion, in the beginning, Kyra makes the point that they've been contact the new Veterans Administration Director General Shinseki and that he hadn't returned their contacts for this report. I'm not going to fault Kyra for whatever point she wanted to make, as she clears that up later in the discussion by pointing out this all happened under the previous administration in 2008. But will say that the General has only been in the lead a very short time, and would not want to speak about all that is coming out finally until he has all the facts, so Kyra think before speaking please!

Salon followed up the first two reports with the following:

"I believe that I did have PTSD"

Matthew Marino was sent back to Afghanistan for a second tour of duty after the Army diagnosed him with "anxiety disorder" instead of post-traumatic stress disorder.

April 10, 2009 | Matthew Marino served five years in the Army and was deployed to fight in Afghanistan twice. He began to suffer from symptoms typical of post-traumatic stress disorder following his first tour. After returning to Fort Drum, N.Y. in late 2004, he couldn't lose the hyper-alertness he'd developed in Afghanistan. He had thoughts of suicide, was nervous, had nightmares, couldn't sleep, and stayed away from family and friends.

Despite his symptoms, however, the Army diagnosed the first lieutenant with anxiety disorder instead of PTSD. He was also diagnosed with depression and given antidepressants. The Army then "stop-lossed" Marino, to prevent him from leaving the Army although his time was up. He was shipped back to Afghanistan for a second tour in 2006. A diagnosis of PTSD might have kept him from being redeployed and sent back into combat; a diagnosis of anxiety disorder did not.

While searching I found a few more reports, following the Salon report, like this one:

Wartime Mental Health, Scandal and Stigma

Posted on April 9th, 2009 by Kelley Vlahos

Nearly a year ago, Secretary of Defense Robert Gates announced that eliminating the stigma of mental health from the military culture would be a Pentagon priority. Seeing that some one-third of soldiers returning from the wars in Afghanistan and Iraq are reporting mental health symptoms, particularly those associated with Post-Traumatic Stress Disorder (PTSD), hearing him say, “We have no higher priority in the Department of Defense, apart from the war itself, than taking care of our men and women in uniform who have been wounded — who have both visible and unseen wounds,” was at the very least, an institutional acknowledgment of the problem.

Good intentions and politically correct language aside, like most of what we see and hear in Washington, his words papered over and have yet to affect a cruel reality, one with which only a small percentage of Americans have any real familiarity. Perhaps with the help of investigative reporters Mark Benjamin and Michael de Yoanna, who have been producing some amazing work for Salon.com, we can all get up to speed.

I would like to make a couple of points to Kelley on an otherwise needed article. First: when Gates made his call he was relatively new in an administration that, while starting two long running occupations, all that is coming out now happened under their watch and with a congress of the same political ideology. Second: we could have all "gotten up to speed" if many had been listening to those of us, in the previous administration labeled "focus groups", had been saying all along, not to mention all of us Veterans who have been saying for years, but welcome to the reality now!!

WWP Concerned by Stigma of PTSD and Mental Illness in Military

In response to recently released information, http://www.woundedwarriorproject.org/Wounded Warrior Project again cited their grave concerns with the manner in which mental health and PTSD are perceived and dealt with within the military. One specific article on Salon.com highlighted concerns that military doctors are being pressured to not diagnose PTSD in returning military personnel and specifically brought to light such a situation in Fort Carson, Colorado.

"Post traumatic stress disorder is very serious," said Nardizzi. "We call on the military to prioritize the reduction of this stigma against seeking care and to foster unfettered access to mental health services, regardless of cost."

VA psychiatrist orchestrates services for increased PTSD patients

Some veterans got proper treatment 20 or 30 years after the issue should have been recognized, he said.

Many returning Vietnam veterans sought refuge from PTSD with addictive behaviors. They were frequently misdiagnosed with schizophrenia and other psychological abnormalities, Otero said. In reality, they were driven to those addictions to mask the increasing severity of flashbacks to horrific combat experiences.

"One of the differences between the current war and the Vietnam conflict is that current vets are receiving counseling and education (about PTSD) before they go and immediately after they return, he said.

"We are trying to catch PTSD early - undiagnosed, it becomes a much more disabling condition," he said.

While the VA mental health community is much more in tune to the workings of PTSD for the new group of veterans, these veterans face some stress issues the Vietnam era combatants did not.

As many Vietnam-era veterans were drafted, they served in the combat zone for a year and were discharged back to civilian life, Otero said.

Now this is for the Veterans and residents of Maryland but others may want to study what they're doing and submit to their state legislators to follow the example, if you don't have similar in your states.

Veterans Network Of Care Portal
Lt. Governor Brown Launches Maryland Veterans Network Of Care Portal

Maryland Department of Health and Mental Hygiene
Press Release:

ANNAPOLIS, MD (March 31, 2009) - Maryland Lt. Governor Anthony G. Brown today joined representatives of the public mental health industry and veterans affairs as Maryland became the first state in the nation to launch a "Network of Care" Website devoted to the state's veterans. The Maryland Veterans Network of Care portal is an on-line resource that provides simple and fast access to information on local, state and national behavioral health services available to veterans. The portal is part of Network of Care online community.>>>>>Rest Here

And those who may be seeking a new profession, have kids looking for a rewarding profession, or are returning Veterans of these conflicts seeking to continue your service to country and citizens of, you may find this worthy to research further.

VA Announces New Nursing Academy Sites
April 9, 2009

To provide compassionate, highly-trained nurses to serve the health care needs of the nation’s Veterans, the Department of Veterans Affairs (VA) is establishing new partnerships with five of the country’s finest nursing schools. With these new partnerships, the VA Nursing Academy will expand the number of collaborations between the department and nursing schools from 10 to 15.

“The expanded role of the Department of Veterans Affairs in the education of nurses will ensure the department has the nurses needed to continue our world-class health care for Veterans,” said Dr. Linda D. Johnson, director of VA Nursing Academy. “The VA Nursing Academy expands the teaching faculty, improves recruitment and retention, and creates new educational and research opportunities.”

The VA Nursing Academy is a virtual five-year pilot program with central administration in Washington. It expands learning opportunities for nursing students at VA facilities, funds faculty development of VA staff for additional faculty positions to competitively selected school partners. The five-year, $59 million program began in 2007.

The names of the newly added schools, as well as those participating already in the program, can be found at the site link.