Post-traumatic stress is felling more troops than the enemy
From Thursday's Globe and Mail
If every illness has a human face, then the face of post-traumatic stress disorder is Roméo Dallaire. Unable to prevent the slaughter in Rwanda, he returned to Canada a shattered man, plagued by nightmares, flashbacks, and lapses into alcohol abuse.
He also gave instant credibility to a diagnosis that is sometimes outrageously abused. Take the case of Roger Borsch, who sexually assaulted a 13-year-old girl, taped her mouth shut, and threatened to kill her if she told.
He blamed his behaviour on PTSD, which, he said, resulted from his tour of duty in Bosnia a decade ago. Last month a judge agreed, and found him not guilty.
Today the Canadian Forces are struggling with a deluge of PTSD cases, and officials warn that our involvement in Afghanistan is bound to make matters worse. Nobody knows how many sufferers there are. Veterans Canada pegs the number at 10 per cent; the military ombudsman says it's more like 20 per cent. One Forces psychiatrist guessed that it could be as high as 50 per cent, depending on the circumstances. Meantime, in the past five years, the number of ex-soldiers collecting disability pensions for stress has rocketed. Some 8,400 veterans have been pensioned off because of psychiatric disabilities, and 68 per cent of those are for PTSD. Many of these pensions have been awarded (long after the fact) to veterans of the Second World War and Korea.
In other words, the casualty rate from PTSD is now far higher than the casualty rate inflicted by the enemy.
It's not fashionable to raise questions about PTSD. But American psychiatrist Sally Satel (who wrote the book One Nation Under Therapy) has done just that. "I am not doubting that this condition exists," she says. "There are going to be some people who are psychologically damaged to the point of no return. I can't tell you how many -- but it's not 20 per cent."
Dr. Satel, whose work experience includes five years in a veterans' hospital, rejects the prevailing notion of PTSD as a permanent disability. "Most people should be viewed as having a temporary problem -- something they'll recover from," she says. But that's not the way the trauma narrative has unfolded in the United States, where PTSD sufferers are presumed to be scarred for life. In fact, the newest flood of claims is not from veterans of Iraq or Afghanistan, but from greying Vietnam vets who are only now discovering that they were psychologically crippled decades ago. Many of them claim their PTSD has been reactivated by violent images from the war in Iraq.
War is hell. But life can be pretty rough, too. You don't need battle trauma to cope badly with it. The slippery part of PTSD is drawing the connection between cause and effect.
"The system has coalesced around the idea that combat is the root of all anguish," says Dr. Satel. "Whatever problems a person may have -- alcohol abuse, erratic employment, domestic violence -- are seen as a product of the war experience."
PTSD is nothing new, of course. It's as old as war itself. And there's no question about our obligation to tend to wounded souls as well as wounded flesh. The question is the best way to do it. "We're so steeped in this notion of PTSD as an irreversible condition that it almost becomes a self-fulfilling prophecy," says Dr. Satel. She also points out (unfashionably) that some people will abuse the system if it is financially attractive and the bar is set too low. Recent studies show that quite a few Vietnam War claimants were not exposed to combat stress at all.
In Canada, the military brass are still in shellshock over a damning ombudsman's report from 2002 that accused them of callously ignoring the PTSD epidemic. Today they've set up PTSD trauma centres across the country, and employ a small army of psychiatrists for diagnosis and treatment. But treatment sometimes increases disability. Retired Major-General Lewis MacKenzie said at the time that the ombudsman's goal of destigmatizing PTSD would "virtually guarantee" an increase in the number of handicapped soldiers. He was widely reviled for this remark, but he was right. As the claims mount up, perhaps we should consider that not every soldier with a problem is Roméo Dallaire. And when stress is mowing down far more troops than the Taliban, maybe something's out of whack.
From Thursday's Globe and Mail
If every illness has a human face, then the face of post-traumatic stress disorder is Roméo Dallaire. Unable to prevent the slaughter in Rwanda, he returned to Canada a shattered man, plagued by nightmares, flashbacks, and lapses into alcohol abuse.
He also gave instant credibility to a diagnosis that is sometimes outrageously abused. Take the case of Roger Borsch, who sexually assaulted a 13-year-old girl, taped her mouth shut, and threatened to kill her if she told.
He blamed his behaviour on PTSD, which, he said, resulted from his tour of duty in Bosnia a decade ago. Last month a judge agreed, and found him not guilty.
Today the Canadian Forces are struggling with a deluge of PTSD cases, and officials warn that our involvement in Afghanistan is bound to make matters worse. Nobody knows how many sufferers there are. Veterans Canada pegs the number at 10 per cent; the military ombudsman says it's more like 20 per cent. One Forces psychiatrist guessed that it could be as high as 50 per cent, depending on the circumstances. Meantime, in the past five years, the number of ex-soldiers collecting disability pensions for stress has rocketed. Some 8,400 veterans have been pensioned off because of psychiatric disabilities, and 68 per cent of those are for PTSD. Many of these pensions have been awarded (long after the fact) to veterans of the Second World War and Korea.
In other words, the casualty rate from PTSD is now far higher than the casualty rate inflicted by the enemy.
It's not fashionable to raise questions about PTSD. But American psychiatrist Sally Satel (who wrote the book One Nation Under Therapy) has done just that. "I am not doubting that this condition exists," she says. "There are going to be some people who are psychologically damaged to the point of no return. I can't tell you how many -- but it's not 20 per cent."
Dr. Satel, whose work experience includes five years in a veterans' hospital, rejects the prevailing notion of PTSD as a permanent disability. "Most people should be viewed as having a temporary problem -- something they'll recover from," she says. But that's not the way the trauma narrative has unfolded in the United States, where PTSD sufferers are presumed to be scarred for life. In fact, the newest flood of claims is not from veterans of Iraq or Afghanistan, but from greying Vietnam vets who are only now discovering that they were psychologically crippled decades ago. Many of them claim their PTSD has been reactivated by violent images from the war in Iraq.
War is hell. But life can be pretty rough, too. You don't need battle trauma to cope badly with it. The slippery part of PTSD is drawing the connection between cause and effect.
"The system has coalesced around the idea that combat is the root of all anguish," says Dr. Satel. "Whatever problems a person may have -- alcohol abuse, erratic employment, domestic violence -- are seen as a product of the war experience."
PTSD is nothing new, of course. It's as old as war itself. And there's no question about our obligation to tend to wounded souls as well as wounded flesh. The question is the best way to do it. "We're so steeped in this notion of PTSD as an irreversible condition that it almost becomes a self-fulfilling prophecy," says Dr. Satel. She also points out (unfashionably) that some people will abuse the system if it is financially attractive and the bar is set too low. Recent studies show that quite a few Vietnam War claimants were not exposed to combat stress at all.
In Canada, the military brass are still in shellshock over a damning ombudsman's report from 2002 that accused them of callously ignoring the PTSD epidemic. Today they've set up PTSD trauma centres across the country, and employ a small army of psychiatrists for diagnosis and treatment. But treatment sometimes increases disability. Retired Major-General Lewis MacKenzie said at the time that the ombudsman's goal of destigmatizing PTSD would "virtually guarantee" an increase in the number of handicapped soldiers. He was widely reviled for this remark, but he was right. As the claims mount up, perhaps we should consider that not every soldier with a problem is Roméo Dallaire. And when stress is mowing down far more troops than the Taliban, maybe something's out of whack.
