No one has been tracking whether or not US veterans have been benefiting in any way from over $3.2 billion annually in mental health treatment programs for post-traumatic stress disorder from the Veterans Administration and Department of Defense, according to a National Academies press release and report from the US Institute of Medicine. An estimated 5 percent of veterans have been diagnosed with PTSD. “Given that the DOD and VA are responsible for serving millions of service members, families, and veterans, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not,” said committee chair Sandro Galea of Columbia University.
The one small PTSD treatment program that was tracked, the researchers noted, yielded “only modest improvements in symptoms.”
Effectiveness of PTSD Treatment Provided by Defense Department and VA Unknown; Tracking of Outcomes Needed to Manage Growing Burden (Press Release, National Academies.)
Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment (2014) (National Academies Press, 2014)
I think this is a completely unfair headline. There is actually a huge amount of data that the treatments being used for PTSD by the VA are effective – a large fraction of it having been done by the VA itself. What this article was saying is that there has not been wholesale tracking of the entire veterans-with-PTSD population *as a whole*, and their clinical change over time, as a QI/research project.
Now, you can argue that it would be good to track this – and that is what the article is suggesting – but it’s important to realize that (a) this is almost never done in any are of medicine and in any health care delivery system, and (b) it’s not something people are universally for, as there are drawbacks. For example, to track this in a systematic way requires that clinicians standardize their assessment and documentation standards such that it can be processed as a huge data set. Ie, if I’m a VA psychiatrist treating PTSD patients, to make this work well, I have to ask EVERY PATIENT I see to regularly fill out standardized symptom checklists and then I have to manually type them into the computer for other people to process. Even if for any given patient, it may be obvious to us that this is not what would would like to be prioritizing with our limited time together.
Hey RCHK, I get your irritation. But if you start going at journalistic newspeak you could start anywhere and get nowhere no matter how often you tried. This is the typical way that they bring a focus into perspective, as allowed by their standards for objectivity. By the very same standards, they publish reports of genes for Real Mental Illnesses, and then never retract them or say sorry.
About the best thing I learned on PTSD came on CSPAN with a panel discussion given by three vets. They were patiently respectful of the V. A., but didn’t think that efforts could be thought advisable to leave just there as though settled. They saw problems with limited efficacy and still appreciated the tremendous amount of work going into it through the V.A. In addition, they recognized the need to work beyond the institutional efforts and to keep reasonable criticisms and also funds of helpful information circulating to help any and all survivors. I mean myself to go back to view this online, as I’m sure Brian Lamb enables.
I think, given the fact more soldiers have died from suicides than in combat, and that the antidepressants do now have a black box warning stating they can cause mania, suicides, and violence, and that the antipsychotics are known to increase the likelihood of a person becoming psychotic, I do think studying the effectiveness of the PTSD treatments should be done.
Oops, I’m glad you commented on this, because I should have clarified: the first line treatments for PTSD are *absolutely* talk-therapy.
Studies of SSRIs and antipsychotics in PTSD have been done, and they have been a mix of no effect and small effects. Studies of psychotherapy (talk therapy) have MUCH better outcomes. Which is why they have been the focus of what is offered veterans by the VA, and are one of the primary indicators discussed in the report.
RCHK — Oh, OK, so maybe this was the inside work of MIA to fashion the headline in this most potentially negative light. Maybe they were motivated by some unseen force to copy the ways of the establishment press or something. I had assumed it was just a lifted headline until looking at the links now.
None of the drugs being used by the V.A. helped me with my PTSD and the assumption of taking the drug all the time, ad nauseum, is specious to me. Most people who suffer PTSD suffer episodically and can go years without being overwhelmed.
A lot of vets have told me that they quit all those drugs and are doing fine just smoking weed. They may still require hospitalization from time to time, but this is also true for people who take antipsychotics for psychotic labels (or as a sedative for sleep problems). None of these medications fixes anything, they don’t prevent flashblacks, night terrors, hypervigilance or psychosis.
Combat PTSD is a powerful psychological condition involving life and death issues and KILLING. It seemed that the V.A. used to acknowledge the profundity of it and were careful to distinguish between PTSD and other psychiatric maladies– like, for instance, making a point not to confuse it with bipolar disorder.
Otherwise, I get good care except for the polypharmacy overkill. I have a week to write a report and make a chart with all the effects of the drugs I’m taking for MS, which I will share with my neurologist, my primary care doctor, and a psychiatric nurse who is serious about side-effects. I’d like to not take amitriptyline, but must cut down very carefully. I already stopped taking two prescriptions I was taking, because the sheer number of pills I need to swallow in a day. It’s laborious, significantly reduces the quality of my days, and I don’t trust most of them. Fortunately, the V.A. always gives vets the right to refuse medication— even in the psyche ward.
The guidelines they’re following include a lot of “preventive” medication that is being peddled hard by the pharmaceutical companies. One of the meds I stopped was Lipitor, which I read up on while taking it. Statistically, if a person has a bona fide heart condition (not risks, but an actual heart condition), then five hundred people would have to be treated with Lipitor to save one life. Weighing that against the risks of taking the drug, is a no-brainer— risks include permanent peripheral neuropathy and permanent muscle cramp (which I have quite enough of with MS, thank you), and profound memory damage (like not being able to remember anything for more that two minutes.
I think they mean well, but some authorities in the system are caught up in the “preventive” whirlwind and polypharmacy and are convinced that it’s best practice that will save lives.
Here’s an article on PTSD my university’s rag published in February:
It pissed me off enough to write the following letter (3rd from top):
Your response was right on, Francesca. It’s war and the sexual abuse of children that is pathological. It’s frustrating to suffer for someone or something’s violation, but I think it preserves the self and connections to others such that we really must examine and question a lot in order to save ourselves. Surviving and overcoming trauma, regardless of what the injury is — and it isn’t a condition that arises in people who aren’t resilient— requires a lot of evaluation and revaluation bit by bit. It’s a soulful and very painful journey that may get deeper and darker with time. The personal story and impact of trauma is unique to the individual, but if often, a societal ill that should concern everyone.
I think it’s a mistake to treat PTSD as a single entity that can be treated the same way for anyone who suffers it. I’m not talking about scales of feeling hurt— it hurts and disturbs as much as the individual who suffers it feels hurt and disturbed, no matter the nature of the trauma. It makes no sense to compare, but as far as dealing with the psychology of the trauma each story has it’s own background and it’s own path to understanding that requires growing with it as much as growing out of it.
“It’s war and sexual abuse of children that is pathological,” in psychiatry’s opinion, so true wileywitch.
I believe that psychiatry functions to tranquilize people in order to cover up abuse, particularly sexual abuse, of children. And now they’re disrespecting and shortening the lives of our veterans, not to mention causing more veterans to kill themselves than died in actual combat. And psychiatric stigmatization is also being used to cover up rape of women and easily recognized iatrogenesis for incompetent and unethical mainstream doctors.
How long will it take for our society to realize that the psychiatrists are not actually providing services that improve our society for the majority within?
Wileywitch– you are totally on the money and making the point as clearly as it can be made, and according to all the various significant things. You must be have worldclass journalling skills along with your great discernment.
I couldn’t journal to save my life. Have tried many time, but I just end up making laundry lists.
Hi Francesca — I read your letter to the editor there, too, and found it without blemish. I just re-read it and re-read the article up to the twirpy analogy about getting your brain fixed or replace with a better model or something. I just react to that with an “oh” and chalk it off that another person who’s no genius at all thinks I don’t have brains, thinks he’s got himself well under control, and knows how to lecture the public and the professions who will not listen at all except to take advantage of the need.
The only realistic expectation involves staunch skepticism in these matters. Please see my post to Someone Else below if you get back around to this reply to you. I study the academic community conversations and they are no better than the media and the typcial mall. So I am a Left-hating liberal for good.
Wileywitch — I hope you get better from the MS bouts. Get better, OK?
So, you have lots of unique experience to put into perspective, and not only from your travails, I’m sure. I wonder if you would see anything in this article:
My specific thought is that just the kind of thing the author discusses seems to pervade most theorizing today, things go back and forth between them who have no “symptoms” and those with hard stories to tell that are loaded with pain and attended by constant grief. The theory and with it the practice gets whittled down, and much of what could have proved helpful to study by way of comparison and contrast has not got its place in the framework. For myself, not having had combat, but early childhood sexual trauma and numerous vehicular traumas, more or less subsequently, I notice that no descriptions at all of differing groups of (maybe purely neurological) “symptoms” are addressed. But the nature of them is causally correlated to incidents and my physical reactions as much as my thoughts during them.
Have you heard of dual representation theory? I know that you will take time for the newsy and scientific articles, like the gene one, and hope that you can see something for your purposes met in this more scholarly one, and one other I have linked to comments before that include with it. What shows for me in my casua lresearch attempts, as I said, is that key formulations like this one Schacter’s get forgotten as the field “moves on”–really, as it updates its fashion commitments. Then the reason for seeing a whole lot of the same thing not how diverse the sources of the testimony, repeatedly standing for similar explanations of “disorders”, that are certainly as unique as the life through which they’re lived, gets more questionable. In fact, the theoretical explanations start to conform to a pattern having to do with the tellers, every bit as much as they reveal one that exists because of the stories and their natural circumstances.
So, the other scholarly article is from my favorite academe writing on mental illness–she’s good enough that it is alright even to let up on the quotation mark festivities. For her, “mental illness” is through and through so-called mental illness.
I hope that you can feel some value and good effect on your life from the impressions of fairness and the subtlety of her engagement with what our issues mean as consumers or victims or patients–as survivors. Maybe if you follow-up a historical overview of PTSD theories you will also see what seems like too much faith in expertise and the mandate for coming up with a final word.
I hope you get better all the way around, and appreciate your contributions, your shared understandings and your efforts to give all you’ve got in your personal life.
“Fortunately, the V.A. always gives vets the right to refuse medication— even in the psyche ward. ”
Wow, maybe then you’re in fact offered better care than the general population (when you finally get through the queue I guess).
I am a US Navy veteran of the Vietnam Conflict. In 1978, before the diagnosis of Post Traumatic Stress Disorder was developed, I was diagnosed with schizo-affective disorder by Veterans Affairs psychiatrists. After eight years of unsuccessful treatment with psychiatric drugs which severely damaged me both physically and emotionally to the point of suicidal ideation, I was extremely fortunate to recover completely within a few months. I had learned about Orthomolecular Therapy and Creative Psychology through my own research and in 1982 was able to obtain a source of this treatment independent from the VA and at my own expense.
My VA psychiatrist, who later rose to the presidency of the American Psychiatric Association, refused to acknowledge my use of Orthomolecular Therapy or Creative Psychology and termed my recovery a “spontaneous remission”. From 1982 to 2007, I lived a healthy, productive life, free of not only psychiatric drugs, but all other prescription medicines as well.
In 2007, concerned about the suicide rate of veterans diagnosed with PTSD, I began to attend a PTSD group at a VA CBOC Clinic . After only a few meetings where I shared my story with other veterans, I was taken aside by a VA psychologist and psychiatrist and diagnosed with paranoid schizophrenia in a twenty minute interview and banned from further participation in the PTSD group.
When this new diagnosis affected the renewal of my life insurance policy, I requested the medical records of my recovery in the 1980s. I discovered that all my mental health records in the 1978 to 1990 time period, had been spoliated. I am convinced that thousands of veterans could have made recoveries similar to mine, with thousands of lives saved, had VA psychiatrists run studies on Orthomolecular Therapy and Creative Psychology instead of destroying all evidence of my drug-free recovery. I have recently been examined and tested by well-qualified civilian forensic psychiatrists, who find in me no evidence of any mental illness.
The fact you were re-“diagnosed” / defamed with schizophrenia for sharing your drug free recovery story, really does show evidence that psychiatrists are trying to cover up / deny unmedicated success stories.
Once I was weaned off drugs, I had to largely avoid mainstream medicine for a while in order to heal, too. Psychiatry’s desire to create lifetime patients, rather than actually help people, is pathetic … and sick, really.
I’m glad you’re doing better, and I’m sorry our government believes in psychiatry’s “medical model.” Personally, as an outsider who ended up researching the industry so as to be able to medically explain how I’d been iatrogenically made ill. It seems obvious to me that the DSM “serious mental illnesses” are likely just lists of symptoms describing the ADRs and withdrawal symptoms of the psychotropic drugs.
Someone Else — Concerning the matters you draw together in your comment, do you think it likely that most psychiatrists that we meet, rather than the KOLs, actually believe pretty much that they can’t buck the system or public opinion? I think that many of them can’t make heads or tails of the plain fact that mental illness is a myth, anymore than philosophers can stop arguing about the mind-body problem which is not a soluble problem: saying mind, body, “I” are just ways of talking about organism and its processes, about persons and personal experience.
So with psychiatrists, who we can’t just ignore like they contain themselves in their ivory towers, because in fact they do things to people that they want to say is for them, it seems clear to me that the less influential ones that I have had to encounter mostly play off the popular superstitions from a position of insecurity. They have all kinds of misconceptions about how to cope with someone who thinks they have a problem but not such that it exists in separate form, beyond how they’ve gotten affected. For me, it was by something that was tons more affecting than they could explain and so they postponed release dates, got suspicious that I was hiding my other symptoms, and turned up the diagnosis. But would they ask about the problems I had. That never happened. And it never happened effectively with psychologists either once there was a label, no matter what I tried to explain.
So the way I see most of these doctors, who it would be inappropriate for me to consult except to tell them about themselves, is that if their label doesn’t stick, they’d better stick one on that’s really not going to come off or else they could get accused of incompetence. Better ruin someone’s chances all the way around, than politely back them out of the wrong line that they found themselves in.
Recently the well known journalist Amber Lyon in an interview told how taking psilosybin mushrooms had rescued her from trauma. She says they saved her life in fact. This feature of the drug is not new. But apparently the VA is not authorized to use it? Why pursue methods of a dubious nature if there is something likely to work? Psilosybin is a virtually non toxic substance though listed as a Schedule I drug. Government is not particularly bright? And there are several other substances that also might be effective. Surely giving these is preferable to suicide which is a common outcome for vets.
Agni Yoga–I will look up Amber Lyon, and what a joke about drug prohibition. Instead of information and levies that increase safety, we have the absolute travesty of Ecstacy getting thought of as relatively benign. If people want to flood their brains with dopamine after seeing what it does upstairs to tissue, oh well. As with alcohol, we can and should only regulate the behavior for public safety and warn, caution, and advise. But LSD is also very safe. There are no excuses for being of two minds about controlling what people think and feel.
I was told by a military chaplain that the treatment for PTSD is working well. What is not evident is whether the military is addressing the moral injury. http://www.huffingtonpost.com/tag/moral-injury/ Moral injury may be the reason for suicide rate among returning soldiers, in my opinion.
Moral injury is no doubt one motivation for suicide, but in my case, and for many vets I have known, “treatment” by a cruel and adversarial VA “mental health” system is justifiably regarded as hostiles taking scalps.
“A Cavalryman’s Poem”
Halfway down the trail to Hell,
In a shady meadow green
Are the Souls of all dead Troopers camped,
Near a good old-time canteen.
And this eternal resting place
Is known as Fiddler’s Green.
Marching past, straight through to Hell
The Infantry are seen. Accompanied by the Engineers,
Artillery and Marines,
For none but the shades of Cavalrymen
Dismount at Fiddler’s Green.
Though some go curving down the trail
To seek a warmer scene.
No trooper ever gets to Hell
Ere he’s emptied his canteen.
And so rides back to drink again
With friends at Fiddler’s Green.
And so when man and horse go down
Beneath a saber keen,
Or in a roaring charge of fierce melee
You stop a bullet clean,
And the hostiles come to get your scalp,
Just empty your canteen,
And put your pistol to your head
And go to Fiddler’s Green.
Isn’t that a big part of what people call PTSD anyway? I mean PTSD is not an illness, it’s just a personal reaction to trauma and extreme life events, which also include committing acts against one’s sensitivity and conscience.
Traumatized people usually do not resolve their trauma by taking antipsychotics or antidepressants. These toxic drugs only push the pain from trauma down, they do nothing for it nor do they resolve it. Trauma must be resolved with a good therapist plus doing some kind of body work. The memory if the abuse, trauma, etc. is saved not only in the brain but in the body too. So, you must work to heal the entire person, not just one part of the person. Actually, mind, body, and spirit must be healed. The drugs heal none of these three parts.
All I see being done for most of our veterans is that they’re pumped full of at least one toxic drug, if not three or four. Young men and women are dying in their sleep or they’re taking their lives by their own hands in phenomenal numbers. Others are ending up in hospitals like the one where I work, where all that’s done is that they’re pumped full of the drugs. The vets still on the battlefields are sent out with huge amounts of psychiatric drugs in their possession. Some VA hospitals are really trying to help people but most just push the pills in large numbers and send people out the doors. The entire system is broken and all that seems to be happening is that a few “band-aids” are stuck on here and there and then everything is supposed to be just fine.
Tranqilization is all they care about. If you’re sitting in a corner drooling then you’re in a good shape because nobody is bothered by you. When you die in that corner that’s even better – money saved. Now ketamine is being studied for its “anti-depressive” properties. It’s a known and dangerous anaestethic, which can cause sudden death (that’s why you monitor patients under anesthesia). Just imagine how awesome it will be when it goes into common use as an “antidepressant”. It’s f***ing insane.
Stephen — Nicely stated. Please keep letting us in on your developing notion of advocacy and real potentials for positive treatment effects. They’re worth the time and effort. I still doubt the need for anything but voluntary assignment and more freedom to choose your lifestyle, backed by good information on just how we were meant to have peace. I sense that Ben Franklin and Thomas Jefferson, if not Lincoln himself, would have thought it better to have War on Prohibition and Fraud. But I’m just some nut.
How surprising… :/