When Sgt. X went to see McNinch with a tape recorder, he was concerned that something was amiss with his diagnosis. He wanted to find out why the psychologist had told the medical evaluation board that handles disability payments that Sgt. X did not, in fact, have PTSD, but instead an "anxiety disorder," which could substantially lower the amount of benefits he would receive if the Army discharged him for a disability. The recorder in Sgt. X's pocket captured McNinch in a moment of candor. (Listen to a segment of the recording here.)
"OK," McNinch told Sgt. X. "I will tell you something confidentially that I would have to deny if it were ever public. Not only myself, but all the clinicians up here are being pressured to not diagnose PTSD and diagnose anxiety disorder NOS [instead]." McNinch told him that Army medical boards were "kick[ing] back" his diagnoses of PTSD, saying soldiers had not seen enough trauma to have "serious PTSD issues."
"Unfortunately," McNinch told Sgt. X, "yours has not been the only case ... I and other [doctors] are under a lot of pressure to not diagnose PTSD. It's not fair. I think it's a horrible way to treat soldiers, but unfortunately, you know, now the V.A. is jumping on board, saying, 'Well, these people don't have PTSD,' and stuff like that."
Diagnosis in psychology is notoriously unstable- for instance, there are numerous studies that demonstrated that multiple experienced clinicians will diagnose a single client in multiple, even mutally exclusive ways. Some diagnoses, like certain personality disorders (e.g. Borderline and Antisocial) seem to have more to do with the person's gender than their conduct. Others are faddish dumps for lazy or frustrated psychologists to drop their difficult clients into- bipolar disorder these days, borderline personality a decade ago.
Still others are patently ridiculous, like diagnosing babies as bi-polar. A few times, perfectly healthy grad students have entered mental hospitals pretending to be psychotic and were unable to get out- everything they did was interepreted as a symptom of their "illness".
Yet, these are examples that point to a significant risk of harm to the individual if diagnosed in a particular way. Dangerous medications, lifelong stigma, emotional distress- all of these can result from a botched clinical experience. In the case of severely injured and highly distressed vets, a PTSD diagnosis is the path of least harm/most benefit to the individual, providing them with the support and care they need.
After all, they didn't make this war. The Bush administration did. They merely fought it. If one assumes that trauma is highly unlikely, one isn't going to be diagnosing much trauma. There is a vested interest in not diagnosing trauma, but rather "pre-existing" syndromes that have been shown to make PTSD far more likely. For example, a history of depression and some personality disorders (which I think usually result from early trauma) are linked to a more severe response to traumatic events.
Additionally, the Army quite deliberately lowered enlistment standards when it was running out of soldiers. Many of these new recruits were psychologically unfit. Many had committed crimes or had a history of serious drug use. These people are especially vulnerable (for these enlistment problems, and the related issue of driving gays out of the military see this.
The cost of this war is staggering. Unlike Vietnam, where some argue the PTSD rate was highly exaggerated in the media (links will come later), this war has thousands of head-injured vets who wouldn't have survived a generation ago. This in itself will make the post-service benefits scenerio entirely different.
Fortunately, the current Senate Armed Services Committee has Jim Webb on it. And Obama was leaning on them hard when he was a senator to investigate this scandal. They refused. We will see.
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