Tuesday, December 27, 2005

The Benjamins and the Veterans

If at first you don't succeed, try again. Have you ever had a flashback? Of course you have. When they are pleasant they are called memories and we willingly revisit them many times. Others that aren't so kind to us we try and forget but they tend to come back at inconvenient times, like when you are trying to make a good impression and you keep remembering the kids laughing at you when you were eight and sometimes you still blush when you think of something dorky that you did.

A Political Debate On Stress Disorder
Experts say the sharp increase does not begin to factor in the potential impact of the wars in Iraq and Afghanistan, because the increase is largely the result of Vietnam War vets seeking treatment decades after their combat experiences. Facing a budget crunch, experts within and outside the Veterans Affairs Department are raising concerns about fraudulent claims, wondering whether the structure of government benefits discourages healing, and even questioning the utility and objectivity of the diagnosis itself.

This is their second try this year. Notice how it comes from people who haven't been to war. My mom, as some of you know, can tell you stories of what it was like to have bombs blowing up your house. She gets still gets twitchy when she hears a certain type of deep roar overhead or a truck backfire. She manages to go about her daily life with very few problems because she is a survivor. She is able to separate her memories from day to day reality and go on with her life. Through the mercy of the universe and the wonders of genetics I have also inherited that ability. Not everybody can do that and history has always had "broken" people after a war. The difference being that most soldiers died of their injuries and now we are able to save people who are missing three limbs and have brain injuries.
Among the issues being discussed, he said, was whether veterans who show signs of recovery should continue to receive disability compensation: "Whether anyone has the political courage to cut them off -- I don't know that Congress has that will, but we'll see."

Much of the debate is taking place out of public sight, including an internal VA meeting in Philadelphia this month. The department has also been in negotiations with the Institute of Medicine over a review of the "utility and objectiveness" of PTSD diagnostic criteria and the validity of screening techniques, a process that could have profound implications for returning soldiers.

Profound implications. As if the war hasn't already rearranged their lives in a negative fashion. Humans are the only creatures on the earth that pay for their mistakes more than once. An animal either dies or is recovers from their mistake and never repeat it. Humans get to replay their booboos ad nauseum and if you don't someone or something will remind you.
"We have young men and women coming back from Iraq who are having PTSD and getting the message that this is a disorder they can't be treated for, and they will have to be on disability for the rest of their lives," said Frueh, a professor of public psychiatry at the Medical University of South Carolina. "My concern about the policies is that they create perverse incentives to stay ill. It is very tough to get better when you are trying to demonstrate how ill you are."

Extremely true statement. Anytime you have to recall an event you lay down more chemical chains of hormones and other assorted biochemical processes thereby reinforcing it and making it more difficult to forget. Studying is boring and static; without smells, sounds or moving visual stimuli to reinforce the item so you go over it many times before it tends to stick. Events with more background or emotional impact tend to be more vivid. I distinctly remember the day my dad died. I can replay it in little flashes when I have to, but I try not to because it makes me sad.
Compensating people for disabilities is a cost of war, he said: "Veterans benefits are like workmen's comp. You went to war. You were injured. Either your body or your mind was injured, and that prevents you from doing certain duties and you are compensated for that."

Scott said Veterans Affairs' objectives were made clear in the department's request to the Institute of Medicine for a $1.3 million study to review how PTSD is diagnosed and treated. Among other things, the department asked the institute -- a branch of the National Academies chartered by Congress to advise the government on science policy -- to review the American Psychiatric Association's criteria for diagnosing PTSD. Effectively, Scott said, Veterans Affairs was trying to get one scientific organization to second-guess another.

War is different from anything you will ever do in your life and America (fortunately) lives in this insular bubble that has prevented us from experiencing it firsthand and we tend to be a little callous towards others. Our lack of empathy for some issues is frightening. Over the last century war has changed. In Vietnam the "enemy" (men, women anc children) popped up out of nowhere to kill the troops. In Iraq they are inside of homes, next to schools and hospitals or part of the police. You live in a heightened state of fear and excitement which makes memories stronger. Coming back to a society that is worried about who is Dancing with the Stars or a "war on Christmas" is disorienting and surreal.

This is about avoiding responsibility. This is a cost of war and should have been factored in at the beginning. We sent them there, we take care of them when they get back. Maybe military policy should be changed to assume that all troops will suffer PTSD and treat them accordingly, make them prove they DON'T have it and treat the ones that do.

This is not a budget issue, these are real lives.

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