Everyday 18-22 American Veterans Commit Suicide and The Department of Veteran's Affairs Still Shows

[unhappycamper]

http://www.opednews.com/articles/Everyday-18-22-American-Ve-by-Jennifer-McClendon-121125-359.html

Everyday 18-22 American Veterans Commit Suicide and The Department of Veteran's Affairs Still Shows Veterans to the Door
By Jennifer McClendon
OpEdNews Op Eds 11/26/2012 at 00:43:45

The point of this Op Ed is to illustrate significant flaws in the system that is set up to treat our veterans. If we continuously operate with a longstanding maladaptive treatment system for our veterans we might want to ask ourselves as a nation what their sacrifice was worth to this nation. We may want to ask ourselves whether we can do better on their behalf.

The Politics of Post Traumatic Stress Disorder (PTSD) treatment is a moral atrocity at the Department of Veteran's Affairs and in military medicine. There is a national discussion between veterans about the treatment of traumatized at the Department of Veteran's Affairs specialized trauma departments.

PTSD can be described as a set of symptoms that are normal reactions to abnormal and tragic stimuli such as war, natural disaster, or sexual assault. Another approach to defining PTSD is to define PTSD as a set of maladaptive traits that developed as a result of a trauma. The latter definition presents the traumatized veteran as flawed or defective. The conditions that cause PTSD are so horrific that referring to the person that suffers, as "Disordered" is a misnomer at best and victim blaming at worst.

~snip~

The term "Disordered" is not the worst part of PTSD diagnosis and treatment. There is a politics that accompany PTSD diagnosis and treatment. Symptoms of PTSD can overlap with several other conditions such as "Bipolar II" and "Borderline Personality Disorder." According to a 2004 Article that was written by pioneer Military Sexual Trauma Advocate Susan Avila Smith:



unhappycamper comment: The VA is trying to help vets but they have neither the people or money resources to do so. Weapons programs are much more needed.

[PDJane]

1. And the GOP have been trying to cut vet's benefits.

Long past time to fix this; regarding people as disposable gets on my last nerve.

[Jackpine Radical]

2. "Overlap" bullshit.

Most individuals with Borderline Personality Disorder (BPD) have histories of extreme and early abuse, often sexual abuse, and many of them can be diagnosed with PTSD. About 3/4 of BPD cases in the general population are women, and most of them were subjected to sexual abuse in childhood.

As for Bipolar Disorder, this is often misdiagnosed in PTSD and BPD cases. Emotional lability is misdiagnosed as a cyclic pattern of alternating depression & manic phases. The key to separating the 2 is, first, taking a good history, and second, noting how rapidly the "mood crashes" alternate with euphoria (or manic irritability). True Bipolar Disorder follows a distinct cyclic pattern of weeks or months, while the emotional lability associated with the PTSD-related conditions can occur within a few days, hours or even minutes.

There are 2 reasons psychiatrists tend to misdiagnose Bipolar when the true condition is PTSD-related. First, they often take 10-minute "intake histories," thereby never even asking the right questions; and second, there are pharmacological means of treating Bipolar Disorders, while there are none (except for marginal symptom-suppression) for the PTSD-related conditions, and psychiatry is heavily biased toward "biological" diagnoses that can be treated with drugs.

[HereSince1628]

4. I particularly agree with your last, long sentence

I can share some personal experience with cPTSD and borderline treatment in the VA in WI.

Like most clinics, VA mental health, looks to treat acute Axis I disorders first. My experience in VA OP-MH is that failure to respond as expected to treatment is what leads to switching from PTSD to something along what's going to become the Borderline--Narcissism spectrum in DSM-V, particularly for men.

In the outgoing DSM-IV as you probably know, there is a list of 9 types of symptoms for Borderline Personality of which various combinations of 5 symptoms will meet the criteria for diagnosis. Consequently, well over 250 combinations of symptoms can be seen as BPD. Yet, one single symptom stands out above all others in making this diagnosis and in conducting clinical evaluations of treatment effectiveness--self-harm. Other characteristics such as extreme emotional lability, and inappropriate anger, are noticed but not diacritically.

However, that isn't true if the BP person is a man...emotional lability particularly when it's raging anger in a man is noticed very quickly. Angry upset men are nearly universally perceived as dangerous, and that determination frequently misdirects observers/screeners to first consider anti-social behavioral aspects. Which leads to one of the sad features of BPD...men with this personality type are more likely to end up jailed than treated.

With respect to the VA, it seems that the demographics of the population it serves has influenced its clinicians' approach to patients. Labile emotions, rage, impulsive behaviors including substance abuse, accompanied with recollections of childhood abuse/neglect are often first perceived as PTSD or substance abuse disorder or both. It is my experience that the VA in Wisconsin tends to be fairly deeply developed to treat both. I admit to some confusion on why in the link in the OP there is a commentary that seems to say that women vets get dx'd as Axis II Borderline rather than Axis I PTSD.

But I do sort of understand how it is that a woman vet diagnosed with BPD might not get treated for borderline within the Veteran's Administration hospitals. Until the last dozen years or so, there wasn't a clinically proven effective treatment for Borderline. That's no longer true, with Dialectical Behavioral Therapy (DBT) being the first to achieve this, in studies of borderline women wherein self-harming was the experimental metric. Certification training in DBT has been slowly developing and DBT certified therapists have very limited availability within the VA. In Wisconsin, for example, DBT-based treatment has been available in modified form thru the Madison VA, but not in any other VA facilities in the state over most of the past years. It seems possible, maybe even likely, that many women vets dx'd as borderline have been told that DBT treatment didn't/doesn't exist with the VA they attended.

My entry into VA mental health began with interventions about para-suicidal behavior, which were initially dx'd as major depression and complex PTSD. After many unsuccessful months of treatment through the VA (not Madison) my dx shifted to borderline illness/closet narcissism spectrum which was unresponsive to months more cognitive behavior therapy provided.

[Jackpine Radical]

5. One reason for Dxing BPD instead of PTSD is the classic presumption

that the personality disorder will pre-date entry into the Service, while PTSD is presumptively service-related. The connection between the two was not recognized for very many years. And still isn't, among "biological" psychiatrists, to whom everything is reducible, and treatable on the level of, neurotransmitters.

Thus the BPD Dx gets them off the hook.

Lots of people were apparently being Dx'd with Pers DOs instead of PTSD for this implicit reason mot long ago.

And incidentally, I have done many (, many, many) evaluations of criminals & it is common to see male BPD's Dx'd Antisocial Personality Disorder. That's the "default Dx" as far as a good many of my ex-Kameraden in Correctional psych are concerned. I, by the way, was not considered to be much of a team player because I kept finding PTSD in the criminal population, both male and female, while everyone else was on this kick about "You're not a victim, you're a GODDAM OFFENDER!"

And, speaking of WI, Taycheedah is basically a secure group home for Borderlines. (For those unfamiliar with WI, that's the women's adult max-and-medium-security prison.) Linehan's DBT has come into great favor there. Or, at least variants of it. The whole program is so cumbersome that hardly anybody does it the way Linehan wants it done.

I recall one of the hardest moments I faced in Wisconsin Corrections, when the superintendent of the adult boot camp, discussing the opening of a women's wing at New Richmond, told me that they weren't going to admit Borderlines into the program.

What was so hard about that moment was suppressing my immediate impulse to break out into uncontrollable laughter.

[HereSince1628]

6. VA eligibility isn't based soley on service-relatedness, many people don't know this.

Examination of these categories shows that various programs are available for treatment of mental illness that shows up AFTER discharge and isn't necessarily related to service.

Priority Group 5...

Nonservice-connected Veterans and noncompensable Service-connected Veterans rated 0%, whose annual income and/or net worth are not greater than the VA financial thresholds.

Veterans recieving VA pension benefits.

Veterans eligible for Medicaid benefits.



Priority 6 includes...

Veterans who don't have a service related condition, but are compensable under specified rules...

Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.

Project 112/SHAD participants.

Veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975. (This is due to PRESUMED Agent Orange exposure of everyone who served within the national borders of Vietnam...vets who served in some other countries with MOSs that exposed them to defoliants are also covered)

Veterans who served in the Southwest Asia theater of operations from August 2, 1990, through November 11, 1998.

Veterans who served in a theater of combat operations after November 11, 1998, as follows:

Veterans discharged from active duty on or after January 28, 2003, for five years post discharge
(this is significant for vets who emerge with PTSD after discharge. Most cases of PTSD show symptoms within 3 months, some cases show up after years,
this category remains available to veterans from Sandlandistan for 5 years after they are discharged)



Priority 7 includes...
Nonservice related, noncompensible

Veterans with incomes below the geographic means test (GMT) income thresholds and who agree to pay the applicable copayment.


Priority 8 includes
Nonservice related, noncompensible
Veterans whose incomes/assets are above the GMT by 10% or less and who agree to make copayments

[Jackpine Radical]

7. I think you're referring to eligibility for VA care, while

I'm talking about service-connected disability pay.

[HereSince1628]

9. Yes, I am because I sensed the op was, in part, about denying vets care.

The system isn't airtight for vets. There are some places where a vet returning from SW Asia can slip thru...

Onset delay by more than 5 years after discharge combined with having reintegrated into civilian life (getting good jobs or marrying people with good jobs) could leave a person ineligible.

-But-, job loss, divorce, bankruptcy (which are pretty common for people with serious mental illnesses) can also contribute to _gaining_ eligibility where previously there wasn't any.

The saddest way I can imagine for a vet to miss an opportunity for mental health care they need would be by the vet just assuming she or he doesn't have eligibility for VA care.

[GeorgeGist]

3. "We might want to ask ourselves as a nation what their sacrifice was worth to this nation."

But of course, we almost never do.

Why? Because the answer is, almost always, NOTHING.

[w8liftinglady]

8. I spent this morning arguing about assistance

We have a large young homeless population in my town....often seen walking down the train tracks (HWY 180,if you've driven between DFW).
1 in 8 are veterans.
There is no public transportation in this "town" of 500,000.
I asked my neighbor which of the mobile homeless was a vet.
She denied that any of them were.
I told her she really needs to learn...maybe she wouldn't be so quick to judge.

These are the nearest locations

http://www.northtexas.va.gov/services/homeless.asp

Arlington is the home of UT-A,were a lot of new vets went after they left service.
A lot dropped out.
Keep the faith,and keep speaking out.