Army Standardizes Ptsd Diagnosis, Treatment

[Squaddiedave]

No, it can be standard, perhaps alike, but its something that effects the individual, and is personal to them, there for just by its nature each person is different.

 

[Tim Cake]

The VA needs to keep the personalized approach. We aren't just a bunch of numbers are we? I know I am a text string.o_O

 

[RC135Linguist]

Naww. It's very simple. The VA just got a billion dollars in extra funds. So we launch a standardization drive and have teams of people travel around and collect data and study. Then we'll have regional meetings and argue for days over bad coffee and sandwich trays about best practice.

After this we will have the National VA Conference in Las Vegas....no no wait. Harry was just there. Ok, We'll do it in Atlantic city. Cheaper. HA! Ok National Meeting. All best practices will be presented and talked about at length for at least 5 days. Nothing will be decided.

Combine all best practices into one big list and role them out as the standard nation wide. All centers suddenly realize they are completely undermanned and unprepared to operate all the best practices. Hiring standards are lowered, salaries are increased. The system is further diluted with clueless retards AND the 1 billion in funds is blown on absolutely nothing, But great success in standardization can be proclaimed.

Is that too cynical?

You forgot the part where they issue another convoluted press release at the end of it all, stating that they have successfully standardized their approach to researching the idea of standardized patient-centered treatment. With that great success under their belts they have applied for and received yet another $billion to move forward - toward some goal that is even more ambiguous than the original one.

 

[Tim Cake]

You just have to *love* those bureaucrats....:rolleyes:

 

[Wagon]

OK. I'm going to go out on a limb here.......and bring my hatchet and start hacking.

I love math, numbers and the little facts. In one of my jobs I used to build models. Real life representations based on fact and then extrapolated into the future. So, with PTSD, I have kind of taken a historical time series data approach.

As far as I can discern, Vietnam kicked off whole series of problems with Veterans which seem inexplicable and incomparable to Korea, WWII or any war before it. It could be a matter of record keeping, but it cannot be the entire story.

Records show that the Allies at the end of WWII captured one....one Rocket Scientist and his papers......and 100% of the psychological warfare and mind control research. Psychological warfare to the Nazis was not a purely enemy focused affair it also very much focused on effective fighting forces. Look at their combat statistics. 98% of German armed forces had been wounded at least once and returned to duty, more than 50% wounded twice and returned to duty amongst other amazing fighting force statistics. The problem of course is what happened to these guys after the war. In Germany the stigma is the Crazy old soldier from the War.

You know the great American tradition of Crystal Meth? One of it's old names was Nazi Speed or Nazi Crank. It was developed.....probably by Baer or one of the other big Pharma's to improve the effectiveness of Soldiers on the eastern front. Russia cold......need speed.

Moving forward......it seems to me that when companies like the Rand Corporation entered into the Vietnam picture something had changed. Something had changed with the training or something had changed with the whole military environment. Homelessness, drug abuse and suicides increased dramatically. Moving further forward, Suicide rates are now 7 times that of Vietnam Vets. Something has happened.

I very much shun the conspiracy theory about things in general. But in a statistical survey of PTSD and in tracking historical relevance or trying to get a grip on a history of the disease you cannot ignore basic facts. Drugs or training, something shifted. This also has to do with rule of law in the military. It is true you sign away your constitutional rights, but you do not sign away your human rights. Two different things I think. It is not stated in too many military documents about the rights of a soldier, sailor, airman or marine.

Then I have to argue against myself. In the statistics world nothing is an absolute. It could be socioeconomic changes. 1968 ended full employment in the west. There began to be unemployed people. The lack of involvement from the home front could also play factors....... you know, less people to listen, less societal involvement in general. War becomes a blurb on the Idiot Box. Who knows. But in a sound survey you can't ignore a good 25 % of the data......just because it may actually be driving statistics.

Oddly enough some of the data is very hard to come by. Some data you have to get a clue from a blog which references a book, which you then have to buy in order to get sound data in order to further your statistics from their sources. It's a crap shoot.

Sorry for the long one a bit off topic.

 

[RC135Linguist]

OK. I'm going to go out on a limb here.......and bring my hatchet and start hacking.

I love math, numbers and the little facts. In one of my jobs I used to build models. Real life representations based on fact and then extrapolated into the future. So, with PTSD, I have kind of taken a historical time series data approach.

As far as I can discern, Vietnam kicked off whole series of problems with Veterans which seem inexplicable and incomparable to Korea, WWII or any war before it. It could be a matter of record keeping, but it cannot be the entire story.

Records show that the Allies at the end of WWII captured one....one Rocket Scientist and his papers......and 100% of the psychological warfare and mind control research. Psychological warfare to the Nazis was not a purely enemy focused affair it also very much focused on effective fighting forces. Look at their combat statistics. 98% of German armed forces had been wounded at least once and returned to duty, more than 50% wounded twice and returned to duty amongst other amazing fighting force statistics. The problem of course is what happened to these guys after the war. In Germany the stigma is the Crazy old soldier from the War.

You know the great American tradition of Crystal Meth? One of it's old names was Nazi Speed or Nazi Crank. It was developed.....probably by Baer or one of the other big Pharma's to improve the effectiveness of Soldiers on the eastern front. Russia cold......need speed.

Moving forward......it seems to me that when companies like the Rand Corporation entered into the Vietnam picture something had changed. Something had changed with the training or something had changed with the whole military environment. Homelessness, drug abuse and suicides increased dramatically. Moving further forward, Suicide rates are now 7 times that of Vietnam Vets. Something has happened.

I very much shun the conspiracy theory about things in general. But in a statistical survey of PTSD and in tracking historical relevance or trying to get a grip on a history of the disease you cannot ignore basic facts. Drugs or training, something shifted. This also has to do with rule of law in the military. It is true you sign away your constitutional rights, but you do not sign away your human rights. Two different things I think. It is not stated in too many military documents about the rights of a soldier, sailor, airman or marine.

Then I have to argue against myself. In the statistics world nothing is an absolute. It could be socioeconomic changes. 1968 ended full employment in the west. There began to be unemployed people. The lack of involvement from the home front could also play factors....... you know, less people to listen, less societal involvement in general. War is becomes blurb on the Idiot Box. Who knows. But in a sound survey you can't ignore a good 25 % of the data......just because it may actually be driving statistics.

Oddly enough some of the data is very hard to come by. Some data you have to get a clue from a blog which references a book, which you then have to buy in order to get sound data in order to further your statistics from their sources. It's a crap shoot.

Sorry for the long one a bit off topic.

PTSD wasn't added to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) nosologic classification scheme until 1980. I don't think it was formally recognized as a bonafide affliction too many years prior to that. In fact, in previous wars leading up to the Vietnam War it was called "combat fatigue" or a condition known as "shell shock," both of which were looked upon as a weakness or personality flaw in the individual. In other words, it was the soldiers' faults and nothing to be dealt with.

All that being said, I'm not so sure anything monumental happened starting with the Vietnam War. When I left the military back in 1975, PTSD (combat fatigue, shell shock, or whatever label was popular then) just wasn't a consideration that was addressed by the military or myself (since it wasn't a formal diagnosis.) I don't know when they began studying the condition or when they began collecting data on it, but I do believe it's been around forever.

Look at it this way: I was diagnosed with PTSD quite by accident because (as I said) it wasn't even a consideration back when I was discharged. I just happened to enter the VA Medical system some three decades or so after discharge when they diagnosed me with it. How many other Vietnam vets are running around with PTSD but, unaware of what it is or how it effects them, they've never been properly diagnosed or treated? I imagine there are all too many of them are not counted in any database. Nowadays, vets are aware of it and way more knowledgeable while they're still serving in the military and immediately upon discharge. So I'm not sure if we're seeing more and more cases of PTSD or if it's just that the medical community (as well as patients) are more aware of it so it's being identified and tracked much more accurately.

 

[Wagon]

Well said VietRecon. And that is one of my points or missions rather. To find a relevant set of numbers that has been tracked all the way through that is indicative of the disease.

Absolutely correct. A change in data collection always makes the graph skewed. So therefore, perhaps things are not so abnormal.

However, there is a suspicious amount of data that is not available that will always further the suspicions of any normal person.....hehe. I said "normal"

 

[JarHed]

To find a relevant set of numbers that has been tracked all the way through that is indicative of the disease.

I agree completely with what ya'll are saying. Part of the problem as well is both the collection and disemination of data. Having worked with information that's gathered from databases I can tell you that there is a vast difference in what data is collected dependent upon how the query that's gathering it is structured. Therefor data can be manipulated to achieve the desired outcome of the users.I know, I've done that for the people that I worked for.

Although PTSD has been around for millenia it hasn't been documented as well as in the past 30 years. Given that soldiers today are more aware of and are reporting more in regard to PTSD the numbers today may seem larger than in the past.Uncollected data is of course unverifiable.

People can always project outcomes with very little real data and have for some time. Probably the best indicators of the numbers of soldiers that have PTSD will be better quantified in the next 50 years of so. I'm sure there will be many other conflicts in the future as well to test these on.

The problem still is how to effectively treat those that have it without developing a cookie cutter approach to patient care.

 

[anthony]

...every case of PTSD and every event that created it is different...so standardized PTSD treatment??? Maybe standardize evaluation and training, that's a good idea...but treatment...like I said, every case is different....just sayin

Not quite actually. There are four tier 1 treatments for PTSD, meaning this have stood the test of time as constantly reliable to partially / fully treat PTSD symptoms based on severity.

The treatment is not what really changes. The specific protocols and discussion within treatment parameters change per persons, obviously, though the broader treatment is a constant. Their are two reasons treatment fails, firstly the client doesn't truly put in the effort and they don't fully disclose to the therapist, and secondly, the therapist isn't applying the common sense principles to adjust the known techniques to the read they get from the client. Combine both, if communication isn't 100% honest from both sides in therapy, there is already an issue present that will cause a lack of treatment.

Time is the significant factor in treatment outcome. What you cannot do is fit every person within this specified window they create. Doing my own counselling qualification I see the idea of a defined period, however; there is a statement in there that maybe many simply don't use, or their organisations have tossed out the window, being you set an amount of sessions, then you specifically state that it can be moved either way, more or less, based on individualism. Severe combat PTSD can take a year or two of one hour per week sessions. You can knock it out in a few months with a lot more than that per week.

I have plenty of mates who are still doing pot and drinking way too much alcohol daily / weekly, and whinge and whine that they can't recover from PTSD. The counsellor gave them homework, they wouldn't do it. They didn't even really try... instead they went to the pub. They then complain that the counsellor isn't fixing them, as though they have some magic wand. PTSD recovery just doesn't work that way, and a person truly has to be willing to open themselves up, get real with themselves, cut out known and proven aspects within their life that hinder them, not help them, and do a shit load of self hard work and education. Put all that together, even the severest of PTSD can be improved so you can atleast go shopping, go out with friends, see a movie, go to a party, etc etc, without panic, anxiety, depression or an incident of violence.

 

[JarHed]

PTSD recovery just doesn't work that way, and a person truly has to be willing to open themselves up, get real with themselves, cut out known and proven aspects within their life that hinder them, not help them, and do a shit load of self hard work and education. Put all that together, even the severest of PTSD can be improved so you can atleast go shopping, go out with friends, see a movie, go to a party, etc etc, without panic, anxiety, depression or an incident of violence.

Anthony your post is golden. If you're getting your qualification for counceling, if I understand it correctly, those that you see will be greatly helped. I think you must have been Sigmund Freud in a former life.

 

[RC135Linguist]

PTSD recovery just doesn't work that way, and a person truly has to be willing to open themselves up, get real with themselves, cut out known and proven aspects within their life that hinder them, not help them, and do a shit load of self hard work and education.

If only it were as easy as it sounds. Given that cynicism and distrust are on most (if not all) lists of PTSD symptoms, it makes treatment quite a challenge. I've been seeing a new therapist on a weekly basis myself since early April this year and there are critical aspects of my behavior that I have yet to share with him. Seriously, I thought that perhaps one of the benefits of paying out of my own pocket for an outside therapist would make me more trustful and, therefore, more open. In some ways it has, but there's still hesitation on my part to discuss some behaviors that, quite frankly, I'm ashamed of. Isn't it funny how the very things we want to be cured of can be so shameful to us that we're not comfortable enough to even reveal them?

 

[Tim Cake]

Not quite actually. There are four tier 1 treatments for PTSD, meaning this have stood the test of time as constantly reliable to partially / fully treat PTSD symptoms based on severity.

The treatment is not what really changes. The specific protocols and discussion within treatment parameters change per persons, obviously, though the broader treatment is a constant. Their are two reasons treatment fails, firstly the client doesn't truly put in the effort and they don't fully disclose to the therapist, and secondly, the therapist isn't applying the common sense principles to adjust the known techniques to the read they get from the client. Combine both, if communication isn't 100% honest from both sides in therapy, there is already an issue present that will cause a lack of treatment.

Time is the significant factor in treatment outcome. What you cannot do is fit every person within this specified window they create. Doing my own counselling qualification I see the idea of a defined period, however; there is a statement in there that maybe many simply don't use, or their organisations have tossed out the window, being you set an amount of sessions, then you specifically state that it can be moved either way, more or less, based on individualism. Severe combat PTSD can take a year or two of one hour per week sessions. You can knock it out in a few months with a lot more than that per week.

I have plenty of mates who are still doing pot and drinking way too much alcohol daily / weekly, and whinge and whine that they can't recover from PTSD. The counsellor gave them homework, they wouldn't do it. They didn't even really try... instead they went to the pub. They then complain that the counsellor isn't fixing them, as though they have some magic wand. PTSD recovery just doesn't work that way, and a person truly has to be willing to open themselves up, get real with themselves, cut out known and proven aspects within their life that hinder them, not help them, and do a shit load of self hard work and education. Put all that together, even the severest of PTSD can be improved so you can atleast go shopping, go out with friends, see a movie, go to a party, etc etc, without panic, anxiety, depression or an incident of violence.

My counselor (three Vietnam tour USMC Force Recon MGYSGT) once told me "Sir -- no pain, no gain -- you have to deal with the shitty memories and overcome them". Reliving them SUCKS -- but it helps relegate them to the dustbin of history. The trick is to do it in a controlled, safe environment under the supervision of a licensed mental health professional.