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Nothing like a hand slap to get things straight.... NOT!
If the party who wrote the email was a GS-9 or GS-11 worker bee;
they'd be looking at likely termination.
-----Original Message-----
Sent: Friday, May 16, 2008 7:46
Subject: "Those who have risked their lives serving our country deserve
far better"
Official Urged Fewer Diagnoses of PTSD
By Christopher Lee
Washington Post Staff Writer
Friday, May 16, 2008; A02
A psychologist who helps lead the post-traumatic stress disorder program
at a medical facility for veterans in Texas told staff members to
refrain from diagnosing PTSD because so many veterans were seeking
government disability payments for the condition.
"Given that we are having more and more compensation seeking veterans,
I'd like to suggest that you refrain from giving a diagnosis of PTSD
straight out," Norma Perez wrote in a March 20 e-mail to mental-health
specialists and social workers at the Department of Veterans Affairs'
Olin E. Teague Veterans' Center in Temple, Tex. Instead, she recommended
that they "consider a diagnosis of Adjustment Disorder."
VA staff members "really don't . . . have time to do the extensive
testing that should be done to determine PTSD," Perez wrote.
Adjustment disorder is a less severe reaction to stress than PTSD and
has a shorter duration, usually no longer than six months, said Anthony
T. Ng, a psychiatrist and member of Mental Health America, a nonprofit
professional association.
Veterans diagnosed with PTSD can be eligible for disability compensation
of up to $2,527 a month, depending on the severity of the condition,
said Alison Aikele, a VA spokeswoman. Those found to have adjustment
disorder generally are not offered such payments, though veterans can
receive medical treatment for either condition.
Perez's e-mail was obtained and released publicly yesterday by, a veterans group that has been critical of the Bush
administration's policies in Iraq and Afghanistan, and Citizens for
Responsibility and Ethics in Washington (CREW), a nonprofit government
watchdog group.
"Many veterans believe that the government just doesn't want to pay out
the disability that comes along with a PTSD diagnosis, and this
revelation will not allay their concerns," John Soltz, chairman of and an Iraq war veteran, said in a statement.
Melanie Sloan, executive director of CREW, said in a statement: "It is
outrageous that the VA is calling on its employees to deliberately
misdiagnose returning veterans in an effort to cut costs. Those who have
risked their lives serving our country deserve far better."
Veterans Affairs Secretary James B. Peake said in a statement that
Perez's e-mail was "inappropriate" and does not reflect VA policy. It
has been "repudiated at the highest level of our health care
organization," he said.
"VA's leadership will strongly remind all medical staff that trust,
accuracy and transparency is paramount to maintaining our relationships
with our veteran patients," Peake said.
Peake said Perez has been "counseled" and is "extremely apologetic."
Aikele said Perez remains in her job.
A Rand Corp. report released in April found that repeated exposure to
combat stress in Iraq and Afghanistan is causing a disproportionately
high psychological toll compared with physical injuries. About 300,000
U.S. military personnel who have served in Iraq or Afghanistan are
suffering from PTSD or major depression, the study found. The economic
cost to the United States -- including medical care, forgone
productivity and lost lives through suicide -- is expected to reach $4
billion to $6 billion over two years.
Ng said diagnosing PTSD often requires observing a patient for weeks or
months because the condition implies a long, lingering effect of stress.
"Most people exposed to trauma, in general, can get better," Ng said.
"You don't want to over-diagnose people with PTSD. Whether it's
adjustment disorder is one thing. It's usually a temporary disorder with
severity that is not as bad as someone with full-blown PTSD."
(c) 2008 The Washington Post Company


I found this a pretty comprehensive survey of the subject.
Post-Traumatic Stress Disorder: A Bibliographic Essay By Lisa S. Beall,
Behavioral Sciences Librarian, Auburn University Libraries
Post-Traumatic Stress Disorder: A Bibliographic Essay
By Lisa S. Beall, Behavioral Sciences Librarian, Auburn University
This is a version of an article published in CHOICE, 1997, 34(6),
Post-traumatic Stress Disorder (PTSD) has captured the minds and
imagination of the American public. Once known as a psychological
disorder associated only with veterans of the Vietnam War, PTSD is now
being considered in relation to many trauma inducing experiences such as
rape, abuse, disasters, accidents, and torture. The result has been a
literal explosion of information on this psychological disorder both in
scientific and popular literature. Thousands of journal articles have
been written on PTSD spawning several specialty journals such as The
Journal of Traumatic Stress and PTSD Research Quarterly. In addition,
many books have been published on PTSD, particularly in the last 10
years. The purpose of this essay is to identify and discuss significant
literature published on PTSD and also to identify some films and
fictional works which have incorporated PTSD into their plots.
Film and Literature
Ongoing public interest in PTSD can be evinced by the popularity of
movies and literature depicting PTSD and individuals trying to cope with
traumatic events in their lives. Obvious examples can be found in the
many fine films about veterans of the Vietnam War. Apocalypse Now
(1979), The Deer Hunter (1979), Heaven and Earth (1993), Birdie (1984)
and Born on the Fourth of July (1989) present Vietnam veterans trying to
cope with the trauma of war, exhibiting many of the classic symptoms of
PTSD such as emotional numbing, denial, startle responses, macabre
interests in recreating traumatizing events, and substance abuse. Many
other films, less obvious, such as Taxi Driver (1976) and Murder in the
First (1995) also depict this disorder. De Niro's character in Taxi
Driver is a Vietnam veteran who sees the city as an increasingly hostile
and filthy place - seemingly the same emotions he feels about his
Vietnam experience. He takes the grave yard shift to cure his insomnia
(one of the many symptoms of PTSD) and armed to the teeth he grapples
with revenge fantasies, rage, and a morbid fascination with the dark
underworld of New York City . In Murder in the First (1995) Kevin Bacon
portrays a prison inmate who is treated in a cruel and inhumane fashion
by the warden and prison guards when he is put in solitary confinement
for three years. He emerges deranged and emotionally catatonic,
exhibiting nothing short of full-blown PTSD. Examples of these types of
films abound, and are consistently well-received by their audiences,
indicating a strong interest in how people deal with traumatizing
Works of fiction depicting PTSD are also popular and widely read. A
classic work of fiction on war trauma is Philip Caputo's A Rumor of War,
which is cited heavily in most introductory works on PTSD in war
veterans. Tim O'Brien - a renowned expert and writer on the Vietnam
experience - recently wrote a finely woven novel entitled, In the Lake
of the Woods, about a Vietnam veteran who is psychologically distraught
by the horrors experienced during his combat experience. Larry
Heinemann's Paco's Story is another example of great literature
depicting a veteran struggling with almost debilitating PTSD. Virtually
any novel about a Vietnam veteran explores symptoms and outcomes of
PTSD. Recently interest in fiction depicting incest survivors has
escalated. This is yet another indication of interest in the post-trauma
experience. The rapidly growing number of novels, histories, and journal
articles about PTSD attest to an urgent, current, and deeply felt public
concern for this disorder.
History of PTSD
One of the most interesting aspects of PTSD is that it has only been
formally introduced into the third edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-III) which begs the
question, "Has PTSD always existed?" And if so, what is the history of
this psychological disorder prior to its introduction to DSM-III in
1980? PTSD did not appear spontaneously in DSM-III but rather it
progressively gained ground and credibility with each new edition. In
the first edition of the Diagnostic and Statistical Manual, published in
1952, stress response syndrome was listed under the heading of "gross
stress reactions." In it's second edition in 1968 trauma-related
disorders were conceptualized as just one example of situational
disorders. Finally, at the persistence of forensic psychiatrists,
DSM-III, published in 1980, listed PTSD as a subcategory of anxiety
disorders. For this classification in DSM-III intense controversy
existed over whether PTSD was an anxiety or a dissociative disorder. In
the most current edition of DSM-IV, published in 1994, the Advisory
Subcommittee on PTSD was unanimous in classifying PTSD as a new stress
response category. Clearly this disorder has achieved increasing respect
in the psychiatric community and continues to evolve in terms of it's
classification in the DSM.
Inclusion of PTSD in DSM-III legitimated this psychological disorder
although many argue that it was merely a re-labeling of what had already
been described as "shell shock," "war neurosis," "traumatic neurosis,"
"combat trauma," or "combat fatigue". This assumes that PTSD is most
applicable to war veterans. Others argue that its origins can be found
in the hysteria research conducted by Sigmund Freud and Pierre Janet in
the late 1800's. Many useful, well-researched and careful overviews of
PTSD history can be found in the books referred to throughout this
essay. Some works on PTSD focus entirely on the historical origins of
this disorder. Images of Trauma, by David Healy provides a lengthy and
thoughtful account of the history of PTSD exploring the origins of
hysteria and the questions raised by Freud and Janet as to whether
hysteria is precipitated by environmental events. Another historical
look can be found in Michael R. Trimble's Post-Traumatic Neurosis: From
Railway Spine to the Whiplash in which the author considers the
neurological aspects of PTSD. Reaching back to studies done on railroad
accident survivors of the 1700's, Trimble explores the biological
components which produce PTSD symptoms. This work also provides
interesting reading on the issue of malingering versus authentic
disorders, most clearly recognized with the advent of railroads and
accidents that could be compensated for with legal action.
Most PTSD authors agree that Abram Kardiner's Traumatic Neuroses of War
and War Stress and Neurotic Illness, are the seminal psychological works
on PTSD. In these works Kardiner distilled much psychiatric thought on
the traumatic syndrome resulting from World War II, with what he had
termed "neurosis of war." The symptoms of this syndrome included
features such as fixation on the trauma, constriction of personality
functioning and atypical dream life. Kardiner provided powerful new
insights in these classic texts on the phenomenology, nosology, and
treatment of war-related stress, thereby anticipating virtually every
aspect of contemporary research on PTSD. Another seminal work on PTSD
was Psychological Aspects of Stress, edited by Harry S. Abram. This
small text, which was composed of six presentations given at a
University of Virginia symposium entitled "Psychological Aspects of
Catastrophic Events" in 1969, is cited frequently in trauma literature
as a major contribution in PTSD development . This symposium, which
examined human response to stressful events, included papers on
psychological reactions to life-threatening illness, concentration
camps, emergency situations, combat, and the stresses of outer space.
John Henry Krystal is another key figure in PTSD research, editing the
ground breaking work Massive Psychic Trauma, which looked at trauma
psychology in concentration camp survivors after World War II. Finally
Mardi J. Horowitz made a major contribution with Stress Response
Syndromes in which he attempted to define the nature and process of
stress-response syndromes. As an outcome of this work and other seminal
projects, Horowitz successfully argued an expectable and predictable
sequence of symptoms follows abnormally stressful life events. These
symptoms (now recognized as the primary symptoms of PTSD) include phases
of outcry, denial and avoidance, intrusion of trauma-related imagery and
affect, and a process of "working through" the psychic problem resulting
from the traumatic event.
Vietnam War Veterans
More has been written about PTSD with reference to war veterans than any
other group. The psychological problems experienced by veterans of the
Vietnam war provided a key catalyst for the inclusion of PTSD in the
nomenclature of the DSM-III. Most of the theory and research for PTSD
has been done on combat veterans, particularly veterans of the Vietnam
War. As a result, many important and influential works have been written
on the severe impact PTSD has had on our Vietnam veterans. To answer the
key question, "just how many Vietnam veterans have suffered from,
PTSD?," a massive study was conducted by the National Vietnam Veterans
Readjustment Study (NVVRS), mandated by the U.S. Congress in 1983 as
part of Public Law 98-160. This study was designed to establish "the
prevalence and incidence of PTSD and other psychological problems in
readjusting to civilian life" among Vietnam veterans. The findings of
this study are reported in Trauma and the Vietnam War Generation: Report
of Findings From the National Vietnam Veterans Readjustment Study,
edited by Richard A. Kulka, and others. Kulka reports that over 30% of
all male veterans, and 26% of the women who participated in the Vietnam
War had PTSD at some time during their lives. This study also found
substantial differences in PTSD rates between minority and non-minority
veterans, with higher rates among minorities. Another important and
influential work on PTSD and Vietnam Veterans is Robert J. Lifton's Home
From the War: Vietnam Veterans: Neither Victims nor Executioners, now in
it's third edition. Lifton explores the severe psychological conflicts
and guilt feelings expressed by returning veterans. Based on the
author-psychiatrist's observation of a selected number of American
soldiers, Lifton provides enlightening commentary and keen insight in
explaining the soldier's feelings.
Another important work on Vietnam veterans and PTSD is Joel Osler
Brende's Vietnam Veterans: The Road to Recovery. This work, written by a
psychiatrist and a clinical psychologist, covers a history of the US
military involvement with Vietnam, the varieties of war experiences of
US soldiers, reactions to returning from the war, and the psychological
effects of that war on the veterans. A more clinical work on the topic -
Post-Traumatic Stress Disorder and the War Veteran Patient, edited by
William E. Kelley - presents a number of viewpoints and theoretical
considerations pertinent to the war veteran suffering from PTSD.
Contributors include leading PTSD experts such as Herbert Hendin, John
P. Wilson, and Joel O. Brende. This work discusses topics such as Black
Vietnam Veterans, Women in Vietnam, Dissociative Disorders associated
with PTSD, and Nursing Care. A particularly good chapter in this book,
"Some of My Best Friends are Dead: Treatment of the PTSD Patient and His
Family," written by Sarah A. Haley, is both touching and courageous.
Jacob D. Lindy's Vietnam: A Casebook, provides a multi- disciplinary
(psychiatry, psychology, medicine, history, English) approach to PTSD as
it relates to Vietnam veterans. This well-received work discusses
psychotherapy treatment using the "Lindy Approach" evaluating Vietnam
veterans through observations, interviews, and standard research
Much of what is written on PTSD relating to war is in the form of
self-narrations and testimonies. Most experts agree that the telling of
their stories and expression of emotions relating to the trauma
experience assists many veterans in recovering from PTSD and proceeding
to live healthy and productive lives. A well-known autobiographical
sketch of a Vietnam vet suffering from PTSD is Ron Zaczek's Farewell
Darkness: A Veteran's Triumph Over Combat Trauma, in which he provides
his experience as a Vietnam combat soldier and veteran. In this
stream-of-consciousness exploration, Zaczek describes his initial
reluctance to seek therapy and recall certain traumatic events and the
important insights he subsequently gains through these therapy sessions.
From Vietnam to Hell, by Shirley Dicks, provides an excellent montage of
autobiographical sketches by Vietnam veterans suffering from PTSD. Dicks
compiled these stories through telephone conversations with Vietnam
Vets, some who are on death row, others who are leading normal lives.
These autobiographies illustrate many PTSD symptoms shared by Vietnam
veterans including guilt, substance abuse, insomnia, emotional numbing,
and a sense of purposelessness. A documentation of experiences unique to
African-American Vietnam veterans can be found in Bloods: An Oral
History of the Vietnam War By Black Veterans, edited by Wallace Terry.
Another montage of personal experiences by Vietnam veterans can be found
in Soldier's Heart: Survivor's Views of Combat Trauma, edited by Sarah
Hansel. This work is a compilation of original prose, poetry and art
written primarily by Vietnam vets with PTSD. The 200 works in Soldier's
Heart depict an outpouring of emotions covering many aspects of combat
stress. In Vietnam: The Battle Comes Home-A Photographic Record of
Post-Traumatic Stress With Selected Essays, edited by Nancy
Howell-Koehler, photographs are the vehicle through which PTSD is
described. Along with the photographs this work includes a series of
essays by expert PTSD scholars such as: Robert J. Lifton, John P.
Wilson, and others. The essays are well-written, providing useful
discussions of the Vietnam experienced and why it produced more
psychological difficulties than previous wars. The black-and-white
photographs in Vietnam: The Battle Comes Home are both artistic and
illustrative of many points raised in the essays.
In spite of the profound impact that PTSD has on the wives and families
of Vietnam veterans, little has been written for this audience. Two
works attempting to reach this audience are Aphrodite Matsakis' Vietnam
Wives: Women and Children Surviving Life With Veterans Suffering Post
Traumatic Stress Disorder and Patience H.C. Mason's Recovering From the
War: A Woman's Guide to Helping Your Vietnam Vet, Your Family, and
Yourself. Matsakis, who has authored several works on trauma recovery
(see section on "Treatment Approaches" for additional works) has an
easy-to-read and approachable style which has become her trademark.
Patience H.C. Mason, the wife of a Vietnam veteran herself, also has a
clear and easy writing style. Both authors delve into issues such as:
why the Vietnam War was different from other wars and how this made it
harder for the veterans to return to civilian life, what the effects of
living with a troubled veteran are, why it is hard to find the right
thing to say to veterans, what help is available to veterans and their
families, and how to deal with the Veterans Administration and other
veterans' organizations. Unfortunately, in both works the focus is
primarily on the Vietnam veterans' experience. Neither work adequately
explores the feelings and emotions experienced by the wives and family
members. Despite this criticism, they are still unique and helpful
resources touching on many key issues experienced by the families
affected by PTSD.
Little has been written about the women who served in the Vietnam War.
One exception is Another Silenced Trauma: Twelve Feminist Therapists and
Activists Respond to One Woman's Recovery From War, edited by Esther D.
Rothblum and Ellen Cole. As the title implies twelve therapists have
interpreted and analyzed the case of one women, "Ruth," a recovering
alcoholic and Vietnam veteran. Originally published as A Woman's
Recovery From the Trauma of War and also as Women & Therapy, Volume 5,
Number 1, Spring 1986, these case studies provide a voice to the less
than 3% of Vietnam veterans who are women. The authors contend that this
small group of women are unacknowledged victims of the war, often
misdiagnosed as "Borderline" and generally recipients of poor treatment
at the hands of male therapists not equipped to work with women.
Although subjective, this book does provide voice to those women who
suffered psychological difficulties such as PTSD as a result of their
involvement in the Vietnam War.
The question of whether certain war veterans were more, or less, likely
to suffer from PTSD is hotly debated and discussed in the literature.
Opinions vary greatly from those who believe that Vietnam veterans are
more prone to PTSD, to those believing that all wars produce the same
types of psychological trauma in their participants. Herbert Hendin's
The Wounds of War: The Psychological Aftermath of Combat in Vietnam
argues that Vietnam presented special circumstances to it's soldiers
which logically would lead to more cases of PTSD. Hendin effectively
demonstrates the circumstances of the Vietnam War which triggered
alarming proportions of PTSD cases. He contends that the lack of
appreciation experienced by these men as they returned from an unpopular
war contributed to their difficulties, but not as much as what they
experienced in combat. The Wounds of War also provides a useful
discussion on the proclivity of certain individuals to PTSD based on
pre-existing psychological difficulties. The Trauma of War: Stress and
Recovery in Vietnam Veterans, edited by Arthur Blank and Stephen
Sonnenberg, also argues that Vietnam War veterans are more prone to PTSD
because this war experience was markedly different from other wars. For
instance, Vietnam was the first unpopular war ever fought by Americans
and it was also the first war reported and portrayed in detail by the
television media.
John Shay's Achilles in Vietnam argues that all wars produce similar
psychological trauma for it's participants. In this brilliant work, war
related trauma is explored by drawing parallels and distinctions between
Homer's account of Achilles in The Iliad and the experience of American
soldiers who served in Vietnam. Shay asserts that many common
experiences for soldiers in both wars manifest in PTSD and that war
always damages the mind and spirit. However, Shay also delineates the
differences between these two wars, which could explain the
preponderance of PTSD among Vietnam veterans. For example, in The Iliad
the dead were mourned by providing a proper burial for the dead whereas
in Vietnam the dead bodies of soldiers were quickly whisked away from
the combat field and almost immediately sent back to the states, leaving
their comrades little opportunity to mourn the dead or engage in any
meaningful death ritual. These differences in the way death was handled,
Shay argues, explains why Vietnam veterans have had so much difficulty
with their war experience.
In addition to drawing parallels between various groups of war veterans,
Steve Trimm finds parallels between Vietnam veterans and Vietnam War
resisters. In Steve Trimm's Walking Wounded: Men's Lives During and
Since the Vietnam War, Trimm argues that both Vietnam veterans and
Vietnam anti-war activists suffered psychological and emotional trauma,
and, that both were treated unfairly by American society. The author
contends that Vietnam veterans were often condemned for serving while
war resisters were condemned for their lack of participation - labeled
anti-American and cowardly. Trimm argues that the vets and the activists
share so much commonality that they form one group - Vietnam Survivors.
Israeli Soldiers
Although PTSD has been most often associated with Vietnam, recently it
has been examined with regard to the war torn Israeli population. Zahava
Solomon's Combat Stress Reaction: The Enduring Toll of War considers the
unique nature of Israeli soldier's exposure to war, particularly the
fact that they have been exposed often to not one, but multiple wars.
Solomon notes that many Israeli soldiers have incurred war related
stress reactions and continue to suffer from deep and debilitating PTSD
residues manifested in psychiatric disorders, somatic complaints and
dysfunctions in social relations. Solomon also examines the notion that
PTSD can be transmitted from one generation to another. She asserts that
trauma experienced by Holocaust survivors may cross biological barriers
and create vulnerabilities to war stress in their offspring. Solomon
also recently authored Coping With War-Induced Stress: The Gulf War and
the Israeli Response in which she writes about the toll war has had on
the Israeli population during the Gulf War. Although Israel did not
officially participate in the Gulf War, it still experienced many of the
features of war, enduring damage and casualties as a result of Scud
missile attacks. This "non-war" exacerbated war trauma issues which
already existed in the Israeli population, creating various stressors
and mental health complaints. Solomon also discusses how the Gulf War
affected Holocaust survivors, evacuees, the mentally ill, and Israeli
soldiers. Stress and Coping in Time of War: Generalizations from the
Israeli Experience, edited by Norman A. Milgram, provides another voice
to this discussion. Most of these chapters were presented at the Third
International Conference on Psychological Stress and Adjustment in Time
of War and Peace (Tel-Aviv, January 1983) and extensively rewritten for
Holocaust Survivors
As would be suspected, PTSD is often linked with Holocaust survivors. An
in-depth examination PTSD among Holocaust survivors can be found in
Human Adaptation to Extreme Stress: From the Holocaust to Vietnam,
edited by John P. Wilson, Zev Harel and Boaz Kahana. Most of the key
PTSD researchers and writers are represented in this work, which is
intended as a primary source for the major theoretical, research and
clinical contributions to war-related traumatic stress. The editor, John
P. Wilson has emerged as a primary figure in trauma research and an
authority on many PTSD populations, including those involved in Nazi
Germany. Other survivors studied in this book include Cambodian refugees
who survived the genocide of Khmer Rouge regime; Vietnam veterans, and
World War II veterans. Shaman Davidson's Holding On To Humanity - The
Message of Holocaust Survivors: The Shamai Davidson Papers, examines
PTSD in Holocaust victims using case studies. Davidson does an
outstanding job of confronting the consequences of victimization and
advocates persuasively for the importance of honesty in the healing
process. Holocaust Survivor's Mental Health, edited by Terry L. Brink
provides further insight on this group of trauma survivors. Chapters
include topics pertinent to Holocaust survivors such as coping
mechanisms, denial, paranoid psychosis, bonding and therapeutic
interventions. The essays included in this book are also published in
the 1994 issue of Clinical Gerontologist. Another source of information
on Holocaust survivors and PTSD is Torture and Its Consequences: Current
Treatment Approaches, edited by Metin Basoglu. This work discusses the
many implications of torture endured by prisoners of war, including
lengthy discussions on Holocaust survivors. Its coverage of PTSD is
interwoven through many chapters addressing the consequences and effects
of torture on individuals.
Finally, a recent work addressing PTSD among Holocaust survivors is
Judith Kestenberg's and Ira Brenner's The Last Witness: The Child
Survivor of the Holocaust. Though many accounts of adults surviving the
Holocaust can be found, this book examines the experience of children
born and raised under the Nazi reign of terror. Based on the interviews
of more than 1,500 Holocaust survivors, this work takes a decidedly
psychoanalytic view of the topic, providing a thorough examination of
the psychological stages of development experienced by these victims and
the short and long-term psychological effects of genocidal persecution.
Although not as numerous, many fine works have been written on women and
trauma. The seminal work on women and rape is Ann Burgess' and Lynda
Holmstrom's Rape: Victims of Crisis. This work is considered the
definitive source on rape trauma even though it was published over two
decades ago. A more current authoritative source on women and trauma is
Judith Herman's Trauma and Recovery - one of the best books on PTSD
written in this decade. It has been extremely well received and widely
reviewed, attesting to its importance in the canon of PTSD literature.
What makes this work so compelling and unique is Herman's well argued
thesis that the systematic study of psychological trauma is dependent on
the support of a political movement. Herman starts by demonstrating that
Freud found the source of hysteria in his female patients to be
childhood sexual abuse. However, because the patriarchal world of Freud
was not ready for this reality, he later retracted this theory and
replaced it with one more in keeping with the political and social
climate of his time - that women with hysteria fabricated stories of
childhood sexual abuse. In the same vain, the study of war trauma only
became legitimate in the context of the anti-war movement and the study
of rape trauma was only given credibility in the context of the feminist
movement. This work, written from a feminist perspective, challenges
many diagnostic concepts. Nonetheless, this work is embraced by PTSD
scholars and researchers alike because it is so sophisticated, both
clinically and philosophically, and accessible to the lay audience.
Although Herman works primarily with abused women and incest survivors,
she has many insights about the male trauma experience as well, bridging
the worlds of war veterans, prisoners of war, battered women and incest
victims. This is a landmark work of luminous intelligence.
Lenore Walker's Abused Women and Survivor Therapy: A Practical Guide for
the Psychotherapist is another work which addresses PTSD in women. In
this work the author presents an integrated picture of the synergistic
effects of interpersonal violence in women's lives, encompassing a wide
range of interpersonal victimization experiences such as physical,
sexual and psychological abuse. For abused women this author calls for a
new form of intervention called survivor therapy, which she contends
provides a better and more appropriate model for these clients. This new
therapy is necessary, she claims, because many women who seek
psychotherapy as a part of their recovery process have experienced
multiple forms of abuse. As a result, existing treatments for each
specific type of abuse are less useful than considering the interaction
of several types of abuse. Also discussed are the differences between
treating women with multiple abuses and treating single trauma patients.
The proposed intervention must include reempowerment, listening to the
women's stories, raising the clients self-esteem, and ending the
isolation which so often accompanies female abuse. Finally, Women Who
Hurt Themselves by Dusty Miller looks at women who do damage to their
bodies, which may include self-mutilation, substance abuse, eating
disorders, smoking, or excessive cosmetic surgery - a category she calls
Trauma Reenactment Syndrome (TRS). These women are "at war with their
bodies," living in secrecy, and preoccupied with a struggle for control.
Miller joins other PTSD clinicians who locate the origin of these
symptoms in a history of severe child abuse.
Prior to the 1950s sparse systematic investigation of the effects of
traumatic events on children or adolescents exists. In contrast, adult
reactions to stress are documented profusely as evidenced by the wealth
of research discussed herein. Obviously children are not free of trauma;
however, they have been presumed to handle stressors much the same way
as their adult counterparts. Recent research on childhood trauma
indicates special considerations, treatments, and approaches are
necessary when working with this population. The premiere work on PTSD
in children remains Post-Traumatic Stress Disorder in Children, edited
by Spencer Eth and Robert Pynoos. As a leading expert in childhood
trauma, Robert Pynoos devotes articles in this brief book to the
increasingly recognized syndrome of PTSD in children. A chapter included
in this work by Elissa Benedeck stresses how the denial of the impact of
trauma on children has contributed to delays in the recognition of PTSD.
Among the many fine contributions, particularly useful is the discussion
of interview techniques for this population, emphasizing the fact that
explicit, thorough investigation of the child's experience is helpful
rather than additionally traumatizing. Beverly James' Treating
Traumatized Children: New Insights and Creative Interventions is another
work which attempts to look at trauma in children. James covers many
issues relating to traumatized children, including guidelines for
evaluation, psychic and physical aspects of trauma, the sequelae of
trauma, the impact on care givers, and programs of treatment. Another
similar work is Victims of Abuse: The Emotional Impact of Child and
Adult Trauma, edited by Alan Sugerman. This work grew out of a
conference, "Victims of Abuse: The Emotional Impact of Child and Adult
Trauma," organized by the San Diego Psychoanalytic Society and Institute
in February 1992. The intent of this work is a heuristic examination of
child and adult trauma, integrating them into a psychoanalytic framework
that emphasizes internal origins of neurosis. Children and Disasters,
edited by Conway Saylor, provides additional discussion of PTSD among
children as it pertains to those victimized by disasters. This work
explores the variety of psychological responses experienced by these
children drawing together data, theory and observational accounts. This
clinical and anecdotal material is woven through many chapters with
discussion of different types of disaster situations (both natural and
man-made) and the impact these experiences have on the children
involved. Another work written for those working with traumatized
children is Kendall Johnson's Trauma in the Lives of Children: Crisis
and Stress Management Techniques for Teachers, Counselors, and Student
Services Professionals. It provides teachers, school psychologists,
health care professionals, mental health workers, and parents with
practical information they might immediately apply to distressed
children to relieve their pain. This work provides information on
intervention strategies designed to reduce the impact trauma has on
these children, including chapters on children's reaction to trauma,
what the schools and therapists can do, and trauma prevention techniques
which can be used with this population.
Few issues in the mental health field have stirred greater controversy
than the recovered traumatic memories of children. Adding fuel and
clarification to this discussion is Lenore Terr's Unchained Memories:
True Stories of Traumatic Memories, Lost and Found. As an undisputed
authority on the subject of children's capacity to remember traumatic
events, Terr provides a well received contribution to this topic. Aimed
at the educated layperson, Unchained Memories provides the reader with
the latest research related to memory. This work points to various
case-studies, each story illustrating particular points and symptoms,
for example, the nature of repression, splitting, dissociation, and the
difference between single and repeated traumatic experiences. Among her
insights, Terr contends that single traumatic events are rarely
forgotten, while prolonged childhood trauma are often repressed and
dissociated. This work is an excellent introduction and review of the
subject. Another work which touches on repressed memories and PTSD from
childhood trauma is Treating Women Molested in Childhood, edited by
Catherine Classen and Irvin D. Yalom. This is a highly readable text
aimed at providing state-of-the-art instruction for those therapists
helping victims of childhood abuse. Recommendations are made for
assessment and diagnosis, as well as treatment programs which can be
employed, such as crisis intervention, individual psychotherapy, group
therapy, couples therapy and hypnosis techniques. The authors of this
work encourage therapists to consider factors such as severity of abuse,
characteristics of the victim, characteristics of the perpetrator, and
context of the abuse when treating young. This is a thoughtful and
well-reasoned work providing a thorough consideration of PTSD among
those clients molested in childhood.
Disaster Victims
No longer seen as a disorder limited to war veterans, many disaster
victims are coming forward with symptoms associated with PTSD. Discussed
in the previous section, Children and Disasters provides a good
introduction to this topic. Another work which considers both children
and adults is Individual and Community Responses to Trauma and Disaster:
The Structure of Human Chaos, edited by Robert J. Ursano, Brian G.
McCaughey, and Carol S. Fullerton. This work examines man-made and
natural disasters such as earthquakes, avalanches, airplane crashes, and
toxic chemical spills, and the general nature of traumatic response to
these disasters. Once technique offered in this book is "Critical
Incident Stress Debriefing" which involves talking people through the
incident, clarifying what actually happened and educating them about
normal psychological reactions to such events. The book contends that
this can be effective protection against full-blown PTSD, as well as the
provision of social support for primary victims and early intervention
to help survivors express emotions about disasters.
In the search for effective, meaningful treatments for those suffering
from PTSD, much has been published. Leading experts in PTSD have made
extremely valuable contributions in developing and reporting treatment
approaches. A key player in PTSD and memory research, Bessel van der
Kolk has contributed three important works to this discussion,
Post-Traumatic Stress Disorder: Psychological and Biological Sequelae,
which discusses many of the complications and physiological aspects
resulting from PTSD, Psychological Trauma, which focuses more on PTSD in
children, and most recently, Traumatic Stress: The Effects of
Overwhelming Experience on Mind, Body, and Society. Traumatic Stress
makes an extremely important contribution to the literature and will
undoubtedly be regarded as an essential resource among PTSD researchers.
With contributions by many leading experts, this work presents the
current state of research and knowledge on traumatic stress and its
treatment. However, expertise and content alone are not enough to lend
such accolades to this work. It is the combination of these factors with
outstanding coverage of the topic, as well as a fluid and thoroughly
engaging writing style, which has resulted in such an exemplary work.
Another leading expert, John P. Wilson, has contributed the well
received, Trauma, Transformation and Healing: An Integrative Approach to
Therapy. In this work Wilson explores the combined effects of
brain-physiology and psychology in understanding the vulnerabilities and
responses to traumatic events. He demonstrates through statistical
research that in the posttraumatic stress syndrome an environmental
cause (trauma) may alter the internal brain chemistry that regulates
affect, especially the emotional states of anxiety and depression.
John P. Wilson has also edited a number of important works on PTSD
including the well respected Human Adaptation to Extreme Stress: From
the Holocaust to Vietnam. In this work Wilson, Harel and Kahana compile
many of the major theoretical, research and clinical contributions to
war-related traumatic stress. Among the many fine chapters in this work
is the often cited chapter by Robert J. Lifton entitled, "Understanding
the Traumatized Self: Imagery, Symbolization, and Transformation."
Wilson has also edited Countertransference in the Treatment of PTSD
(with Jacob D. Lindy). Countertransference is the phenomenon in which an
analyst either shifts feelings from his or her past onto a patient or is
affected by the client's emotional problems. Often, the same issues that
cause victims to become fixated on the trauma (numbing, dissociation,
fascination, revulsion, rescuing and blaming) obstruct therapists in
their attempts to undo the effects of trauma. Countertransference has no
therapeutic benefit and can only be a potential source of interference
with the patient-therapist relationship.
John H. Krystal is another important figure in PTSD, authoring the well
respected and much cited book entitled, Integration and Self-Healing:
Affect, Trauma, Alexithymia: Psychoanalytic Reformulations - a synthesis
of Krystal's clinical and theoretical work . This book is a scholarly
and probing exploration of the vital role integration has in recovery
from traumatizing events. Because traumatizing events are so disturbing
for victims to recall, sometimes these individuals will develop
alexithymia - an inability to describe one's feelings or mood. The
objective, according to Krystal, is to integrate the perception of the
traumatizing situation. Krystal's many decades of study and clinical
involvement with PTSD patients provide a valuable clinical perspective
to this discussion of treatment.
Lisa I. McCann's Psychological Trauma and the Adult Survivor: Theory,
Therapy and Transformation is tremendously popular among experts in the
field. In this exemplary work McCann presents a conceptual framework for
assessing and treating traumatized individuals called constructivist
self-development theory (CSDT), which blends object relations,
self-psychology, and social cognition theories. In this model, trauma is
a result of a complex interplay between life experiences (including
personal history, specific traumatic events, and the social and cultural
context) and the developing self (including self capacities; ego
resources; psychological needs; and cognitive schemas about self and
world). According to McCann, the individual's unique response to trauma
is a complex process that includes the personal meanings and images of
the event, extends to the deepest parts of a person's inner experience
of self and world, and results in an individual adaptation. The
underlying premise of CSDT is that human beings actively create their
representational models of the world. McCann, founder and clinical
director of the Traumatic Stress Institute, also provides a careful
review of scientific literature related to trauma in this work.
Trauma and Its Wake, a two-volume work edited by Charles R. Figley is
another heavily cited and respected work on the treatment of PTSD.
Figley, director of the Traumatic Stress Research Program of the Family
Research Institute at Purdue University, is renowned for his work on
stress in the family. Charles Figley also authors Helping Traumatized
Families and edits Compassion Fatigue: Coping With Secondary Traumatic
Stress Disorder in Those Who Treat the Traumatized, as well as Beyond
Trauma: Cultural and Societal Dynamics. In Compassion Fatigue Figley
provides a much needed consideration of the issues surrounding in-depth
exposure to those who are traumatized. Figley explains why therapists
sometimes take on the pathology of their PTSD clients, experiencing
intrusive thoughts, nightmares and general anxiety like their patients.
Beyond Trauma looks further than the individual's psychological dynamics
of trauma and explores social, cultural, political, and ethical
dimensions of this disorder.
Frank M. Ochberg, international expert in the field of PTSD, edits
Post-Traumatic Therapy and Victims of Violence. This well written and
organized work focuses on a wide variety of victims and treatment
methods, with contributions by many well-known scholar-clinicians.
Ochberg demonstrates the essentiality of understanding the many stages
of trauma such as bereavement, victimization, autonomic arousal, death
imagery, and negative intimacy. This book provides insight and practical
guidance for those working closely with victims of violence.
Finally, Aphrodite Matsakis' authors Post-Traumatic Stress Disorder: A
Complete Treatment Guide, I Can't Get Over It: A Handbook for Trauma
Survivors, and Vietnam Wives: Women and Children Surviving Life With
Veterans Suffering Post Traumatic Stress Disorder (see section on
Vietnam), is often cited among those writing on PTSD. Her most recent
PTSD publication, Post-Traumatic Stress Disorder: A Complete Treatment
Guide, provides an introduction to PTSD for clinicians who want to learn
about the variety of treatment strategies used with these types of
patients. Matsakis includes cognitive and behavioral techniques for
managing flashbacks, anxiety attacks, sleep disturbances, and
dissociation. Matsakis presents the material in an easy-to-read,
approachable text which has become a distinguishing characteristic of
all her works.
Counseling approaches which can be applied to PTSD sufferers are
discussed in various sources. Sandra L. Brown's Counseling Victims of
Violence is one which points to practical approaches for counseling
victims of violence. Brown provides insights on victim concerns,
intervention techniques, social service agencies, short-term, and
long-term counseling issues. Brown does not specify "how-to" techniques
for counselors and therapists working with trauma victims; rather she
describes a developmental intervention strategy approach, familiar to
most counselors, which includes education, awareness, and realistic
optimism. Integrative counseling strategies are pointed to throughout
because victims of violence often require a variety of support networks
(e.g., crisis intervention, suicide prevention, substance abuse
counseling, group counseling, etc.) Brown recommends expert treatment
teams for each case. Brown also discusses the high burnout rate
experienced by trauma victim counselors. Michael J. Scott's Counseling
for Post Traumatic Stress outlines and illustrates a range of
predominantly cognitive-behavioral techniques for dealing with the three
main symptoms of PTSD: intrusive thoughts or images, avoidance
behaviour, and disordered arousal, especially irritability. Scott
concludes with discussions on substance abuse among PTSD sufferers, the
efficacy of group counseling, and difficulties experienced by PTSD
counselors. John Leach's Survival Psychology examines the psychological
functioning that occurs during traumatic events. Leach contends that
although much attention is given to the aftermath of traumatic events,
such as disasters, comparatively little is focused on understanding and
appreciating the psychology of the individual during the actual period
of threat. Geared toward those who are typically on the scene during
trauma inducing experiences (e.g., fire persons, red cross workers,
police officers, etc.) this work considers what can be done to help
victims at the actual time of the trauma.

One work dedicated to the psychoanalytic considerations of PTSD is
Richard B. Ulman and Doris Brother's The Shattered Self : A
Psychoanalytic Study of Trauma. The authors define trauma as a "real"
occurrence, the unconscious meaning of which so shatters central
organizing fantasies that self-restitution is impossible. The authors
reject, as over simplistic, the notion that the traumatic event in
itself holds psychological meaning to the person experiencing it.
Instead they argue that traumatic events shatter archaic and
narcissistic fantasies which are central to the organization of
self-experience, and, that in the subsequent faulty attempts to restore
these fantasies lies the unconscious meanings of the traumatic events.
The meaning that one attaches to the traumatic event is what actually
changes the person's experience of self. This weighty and dense analysis
is appropriate only for those with a solid background in psychological
theory. Another more current work on PTSD, also authored by Doris
Brothers, is Falling Backwards which explores issues of trust
(particularly self-trust) and betrayal inherent in the trauma
experience. This is also a scholarly work which includes in-depth case
studies to illustrate key points and culminates in suggested therapeutic
intervention techniques involving psychotherapy. Melvin Lansky looks
specifically at dream interpretation in Posttraumatic Nightmares:
Psychodynamic Explorations. Having found that traumatized patients have
a high incidence of chronic nightmares, Lansky discusses the use of
dream analysis as a vehicle for understanding the affective elements of
PTSD. Although many experimental difficulties are associated with dream
analysis, important discoveries have been uncovered through this type of
research. For example, the role of shame in PTSD has been further
understood through dream research. This is a well written, thoughtful
account providing many useful insights for those treating PTSD patients.

A Jungian interpretation to PTSD can be found in Emmett Early's The
Raven's Return: The Influence of Psychological Trauma on Individuals and
Culture. In this compelling work, Early examines the archetypal nature
of psychological trauma, particularly as it applies to combat veterans.
By examining the fairy tales, fables and folklore which have been handed
down through the ages, this author is able to argue persuasively that
much classic literature has elements of trauma survival woven through
it, indicative of the timeless, collective struggle human kind has with
trauma. Early finds elements of PTSD in fairytales such as Cinderella,
Little Red Riding Hood, Snow White, Blue Beard, and Beauty and the
Beast, as well as in modern day fables such as Superman and Batman. The
characters in these stories are often abused and abandoned and bent on
avenging the evil forces that traumatize them. They dichotomize the
world into good and evil and seek situations that replay the trauma
experience. The author shows how these same feelings and behaviors are
found in PTSD sufferers such as war veterans and rape victims. Early
asserts that these tales are so popular across cultures precisely
because they express fundamental human problems created by psychological
trauma and provide an emotional outlet for people struggling with
Cognitive Behavioral Therapy
Two works which focus specifically on cognitive behavioral approaches in
PTSD are David W. Foy's Treating PTSD: Cognitive-Behavioral Strategies
and Philip A. Saigh's Posttraumatic Stress Disorder: A Behavioral
Approach to Assessment and Treatment. Saigh's Posttraumatic Stress
Disorder is a very good source for practitioners interested in the
assessment and treatment of PTSD. In addition to providing behavioral
and cognitive-behavioral treatment programs for PTSD, Saigh also
provides an excellent overview of the history, current nosology,
epidemiology, and etiology of PTSD. Saigh focuses on two behavioral
techniques: exposure-based procedures and anxiety management techniques
(AMT). Exposure treatment is a set of techniques with a common
denominator involving the confrontation of feared situations and is used
when the disorder involves excessive avoidance. AMT, on the other hand,
is used when anxiety pervades daily functioning. In this case, fear
management is more significant than fear activation. AMT techniques
discussed by Saigh include: relaxation training, stress inoculation
training, cognitive restructuring, breathing retraining and distraction
techniques. Foy provides a straightforward guide for implementing
cognitive-behavioral strategies in the treatment of PTSD sufferers, as
well as clear guidelines for war veterans, sexual abuse survivors, and
battered women. Foy has collected treatment protocols, most with proven
efficacy, in use at established centers. Most importantly, Foy's work
presents a "cross-trauma" perspective that highlights the similarities
of the treatment of PTSD in a variety of different traumatized
populations. Interventions discussed in Foy's work include fear
extinction, cognitive restructuring, flooding, and skills training. Both
Saigh and Foy discuss the complications of comorbidity in treating PTSD
patients, particularly drug and alcohol abuse, depression, and anxiety
Lee Hyer's Trauma Victim: Theoretical Issues and Practical Suggestions
is another work heavily influenced by cognitive behavioral therapy. In
this work Hyer provides a model of trauma best understood by its overall
impact on the person giving much consideration to each individual's
"schemas" and "personality styles." Hyer asserts that the schemas
provide the essential structural base for the
cognitive/affective/behavioral components of each individual while the
personality style consists of self perpetuating patterns that are stable
aspects of an individual's mode of engaging the world. Together they
influence the expression of beliefs and symptoms associated with trauma.
Finally, Patricia A. Resick and Monica K. Schnicke's Cognitive
Processing Therapy For Rape Victims: A Treatment Manual, addresses PTSD
among rape victims. This manual offers a session-by-session treatment
plan for therapists counseling rape victims who are already familiar
with cognitive approaches to therapy. These authors feel rape victims
most often show symptoms of either PTSD or depression. The treatment
plan includes written work by the client about what rape means in order
to show the therapist where the client is "stuck" and to provide an
emotional outlet for the client. The text also includes chapters about
group versus individual treatment; client characteristics that may
affect treatment; therapists' gender; and the results of cognitive
processing therapy in a group of the authors' clients.
Maggie Phillip's Healing the Divided Self: Clinical and Ericksonian
Hypnotherapy for Post-Traumatic and Dissociative Conditions provides
solutions to those therapists who are having difficulty accessing
unconscious material from trauma survivors through the use of
hypnotherapy. In this work Phillip's contends that failure to access
unconscious material may leave the PTSD patient vulnerable to a return
of their problems. Recent PTSD clinicians find that "hypnoanalysis" has
considerably shortened treatment time. In this work Phillips identifies
and discusses a technique called "Ego-state therapy," defined as the use
of group, family and individual treatment techniques to resolve
conflicts between the various "ego states" within a "family of self."
Beyond an exploration of ego-state therapy, this work attempts an
integration of findings and methods drawn from psychoanalysis,
hypnotherapy and Ericksonian methodology.
Treatment Overviews
R.J. Kleber's Coping With Trauma: Theory, Prevention and Treatment
presents a general and systematic perspective on responses to traumatic
events. It provides an integration of theoretical models and research
findings derived from scientific literature. In addition to the
theoretical models, a number of treatment methods for PTSD are
described. Post-Traumatic Stress Disorder: A Clinician's Guide, edited
by Kirtland C. Peterson, Maurice F. Prout and Robert A. Schwarz also
points to a variety of treatment programs for clinicians working with
PTSD sufferers. This work, although now slightly dated, is an excellent
source, describing the primary symptoms associated with PTSD and a
variety of therapeutic treatment approaches which can be used such as:
dynamic psychotherapy, behavioral treatment, hypnotherapy,
narcosynthesis, group treatment, family and couples therapy, and
psychopharmacological treatment. A similar, but more current monograph
is Traumatic Stress: From Theory to Practice, edited by John Freedy and
Steven Hobfoll. Freedy and Hobfoll also synthesize the current
scientific theory and knowledge of PTSD in this thorough textbook
examination of the topic.
Diana Everstine's The Trauma Response: Treatment for Emotional Injury,
is another source which provides an overview of treatment programs.
Everstine differentiates the terms "trauma response" and "trauma
disorder," however, the term "trauma response" is nowhere clearly
defined. Among the treatment approaches offered are a variety of
techniques ranging from the behavioral to psychoanalytic therapies.
Everstine is particularly thorough in her discussions of PTSD in
children. Another similar work is Psychotraumatology: Key Papers and
Core Concepts in Post-Traumatic Stress, edited by George S. Everly, Jr.
and Jeffrey M. Lating, perhaps the best overview work available,
compiles articles, scholarly reviews, and previously published papers on
PTSD. It covers a large and diverse body of knowledge on PTSD in a well
organized and well indexed text. The diversity of articles and
approaches do not feel disparate and unconnected as in similar texts.
And to its merit Psychotraumatology provides many original and fresh
approaches to the topic, such as the chapter on the use of 12-step
programs and spiritual steps as a means of recovery from trauma.
The International Handbook of Traumatic Stress Syndromes, edited by
leading expert John P. Wilson is an essential resource for PTSD
research. This tour de force on the cumulative knowledge of PTSD is well
edited , thoroughly researched and carefully organized with
contributions by numerous leaders in the field of trauma research. The
Handbook of Post-Traumatic Therapy, edited by John F. Sommer and Mary
Beth Williams is another excellent handbook providing a comprehensive
and in-depth look at PTSD. Sommer and William create a conceptual
framework for diagnosing, treating and assessing posttraumatic stress in
survivors of violence, abuse, war, political torture and disaster.
Chapters are devoted to creative therapies, group interventions, and
several new trends. Contributors include John P. Wilson, Aphrodite
Matsakis, Joel Osler Brende, among many other key researchers. Here also
is an extensive bibliography of material published about PTSD. Another
fine handbook on PTSD is Merrill Lipton's Posttraumatic Stress
Disorders--Additional Perspectives. Lipton, a WWII veteran, writes this
book to guide Psychologists, Psychiatrists, and Counselors in making
accurate diagnoses of PTSD and treatment of this disorder. Lipton
indicates treatment methods with an emphasis on reducing situations
triggering memories of the traumatic experience. Posttraumatic Stress
Disorder: A Clinical Review, edited by leading expert in childhood
trauma, Robert Pynoos, is a thorough and timely review of the field of
PTSD with contributions by many distinguished professionals in the
field. Another handbook is The Handbook of Post-Disaster Interventions,
edited by Richard D. Allen, a special issue of The Journal of Social
Behavior and Personality (Vol. 8 No. 5 1993) focusing on formats for the
effective treatment of PTSD. This volume contains three sections:
treatment of PTSD, organizing mental health services following disaster,
and psychological reactions to disaster. This is an important, timely,
and extremely useful handbook covering conceptual theories of trauma
response, the impact of disasters on emergency responders and
volunteers, special clinical work with children affected by disaster,
and cross-cultural and ethnic considerations among disaster victims.
Although the lion's share of treatment oriented works on PTSD are
written with the practitioner in mind, a handful of books have been
written with the PTSD sufferers as their primary audience. Benjamin
Colodzin's Trauma and Survival: A Self Help Learning Guide is an
outstanding source for war veterans suffering from PTSD. Colodzin
outlines a practical and compassionate program, drawing on both modern
and ancient knowledge, for viable solutions for those suffering from
traumatic experiences. This work is particularly useful in its
examination of communication processes and anger. Colodzin writes this
book with obvious care and compassion for PTSD sufferers. Raymond B.
Flannery's Post-Traumatic Stress Disorder: The Victim's Guide to Healing
and Recovery, is written specifically for PTSD survivors and their
families. This clear and insightful book describes PTSD, including the
links between addictions and traumatic stress, and shows survivors how
to master the skills of stress-resistance.
Barry M. Cohen's Managing Traumatic Stress Through Art: Drawing From the
Center provides another self-help approach for PTSD. Three art
therapists have collaborated to produce this unique workbook. Designed
for the trauma survivors, this work introduces inventive ways to
understand, manage, and transform the aftereffects of trauma. This work
could help survivors to explore the aftermath of trauma as it affects
self-image, relationships with others and functioning in the world.
Richard G. Tedeschi and Lawrence G. Calhoun's Trauma and Transformation:
Growing in the Aftermath of Suffering provides another perspective for
those recovering from trauma. Tedeschi weaves together material on the
experience of personal growth or strengthening that sometimes occurs in
persons who face traumatic events. Tedeschi posits that growth occurs
because trauma leads to change in belief systems and these beliefs
assist in relieving emotional distress and encouraging useful activity.
Biological Aspects
The fact that markedly stressful situations, or traumatic stress, can
cause long-term physiological and psychological problems has been
recognized for centuries. Neurobiological and Clinical Consequences of
Stress: From Normal Adaptation to PTSD, edited by Matthew J. Freidman,
Dennis S. Charney and Ariel Y. Deutch covers most aspects of laboratory
and clinical research on neurobiological consequences of stress and
trauma. The guiding principle of this book is that humans exposed to
catastrophic stressors utilize the same neurobiological mechanisms that
are activated following exposure to less severe "normal" stressors.
These authors assert that much can be learned by extrapolating from
research on the normal stress response in humans. Unsuccessful
adaptation may result in an equilibrium state which, though stable,
deviates significantly from normative neurobiological standards. This
book has sections on basic neurobiological research on stress,
neurobiological models of stress and PTSD, and clinical issues regarding
diagnosis and treatment. Catecholamine Function in Posttraumatic Stress
Disorder: Emerging Concepts, edited by Michele M. Murburg, provides a
comprehensive summary of data and theories from multiple animal and
human studies about how the neurotransmitter catecholamine functions in
PTSD. Although Murburg admits that many other neurotransmitters and
neuroendocrine systems respond profoundly to stress and may also exhibit
altered function in PTSD, the focus of this book is on those clinical
findings that suggest altered catecholamine functioning.
Legal Aspects of PTSD
When the diagnosis of post-traumatic stress disorder (PTSD) was first
officially created by DSM-III in 1980, it is doubtful anyone fully
appreciated the impact it would have on psychic injury litigation. Today
PTSD has been alleged in a variety of claims - from malpractice, rape,
sexual harassment to child abuse and combat trauma. Several well
researched books address the legal aspects of PTSD. One particularly
well written and clearly organized book is Post-Traumatic Stress
Disorder: Assessment, Differential Diagnosis and Forensic Evaluation,
edited by Carroll L. Meek. Meek collates a number of cohesive and useful
essays on the legal issues pertinent to PTSD exploring such topics as
differential diagnosis, Vietnam veterans, childhood sexual abuse
victims, imagined, exaggerated and malingered PTSD, and forensic issues,
definitions, procedures and guidelines for expert witnesses involved in
PTSD litigation. Posttraumatic Stress Disorder in Litigation: Guidelines
for Forensic Assessment, edited by Robert I. Simon, is another unique
source providing guidelines for forensic psychiatric and psychological
assessment of PTSD claimants. These guidelines are intended to assist
forensic examiners in performing credible examinations of PTSD claimants
that should benefit both plaintiffs and defendants. C.B. Scrignar's
Post-Traumatic Stress Disorder: Diagnosis, Treatment and Legal Issues
gives the practicing clinician a fundamental approach to understanding,
treating, and forensically assessing individuals with PTSD. Throughout
the book Scrignar conceptualizes PTSD by using a biopsychosocial model
containing the three E's, representing environment, encephalic events,
and endogenous events. This uncomplicated model is aimed toward
facilitating effective communication when presenting PTSD to attorneys,
judges, and juries. Readers should find this work of interest as an
illustrative introduction to forensic psychiatry; however the two
previous works discussed provide more detailed and current coverage of
this increasingly important aspect of PTSD.
Amidst all the scientific inquiry and serious scholarly consideration
given to PTSD, a growing skepticism exists for this syndrome. Many are
reluctant to accept the disease model believing that the psychiatric
community fabricates this disorder for purposes of providing
compensation and support to trauma sufferers such as Vietnam veterans.
Adding fuel to this argument is Allan Young's The Harmony of Illusions:
Inventing Post-Traumatic Stress Disorder, in which he asserts that PTSD
is neither timeless nor universal but rather a cultural product, a
reality glued together by the psychiatric profession's diagnostic
technologies, styles of scientific and clinical reasoning, and, the
patient's self-narration and confessions. This controversial book should
spark much debate. However, in the face of this backlash, research on
PTSD continues to flourish. All indications show that public and
scientific interest is steadily increasing and that much more will be
written on this psychological disorder before this century turns. The
works discussed in this essay serve as a foundation for assisting that
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Hi everyone. This email is to inform you that the PTSD site, including the forums, is moving to the following address soon:
This should happen within the next week and there may be a few days of downtime before the transition is complete. We anticipate it to be up and running by January 28th at the latest.

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Grieving kids may also have PTSD
ATHENS, Ga. (UPI) -- A University of Georgia study said children who have lost a parent to diseases such as cancer can suffer post-traumatic stress disorder.
Study co-author Rene Searles McClatchey said she found grief therapy to children whose parent died doesn't help if the post-traumatic stress disorder symptoms aren't dealt with first.
McClatchey is founder and director of Camp Magik -- a non-profit organization that provides weekend camps for children that blend camp activities such as hiking with therapy for PTSD and grief.
McClatchey and colleagues studied 100 children to test the effectiveness of a camp-based PTSD intervention and found the odds of continuing to experience severe PTSD were 4.5 times higher for children who did not attend the camp compared to those who did.
The study, published in Research on Social Work Practice, found the odds of experiencing severe grief were 3.6 times greater for children who did not attend the camp than for those who did.
The study showed camp-based interventions work and found a link between PTSD and grief. A previous study conducted in 2005 in which children attended camp and underwent grief counseling without PTSD treatment found the children did not improve or, in some cases, fared worse.
Copyright 2008 by United Press International


Matthew Ford wrote:

Please enter the following and make note of the statements and accompanied references. Great reading!

Spread the word folks! I haven't seen any of this
in the papers.


VA Announces New Guidelines For PTSD Claims
In the past when a Servicemember filed a claim for PTSD, they had to
also provide written verification that they witnessed or experienced a
traumatic event. That written verification had to be a statement from a
commander, doctor or fellow servicemembers, stating that he or she was
involved in a traumatic situation leading to PTSD, before the could
receive disability compensation for PTSD from the VA. Today, the
Veterans Affairs Department announced that combat veterans will no
longer have to verify in writing that they have experienced a traumatic
event, according to the chairman of the Senate Veterans' Affairs


A Review of the Conditions and Benefits
Linked to Agent Orange Exposure
Editor:  Bob Kozel
Table of Contents
1.0  Introduction                                                                                                                
1.1   Brief History of Agent Orange Use and Follow on Health Studies                                           
2.0  Agent Orange and Service Connected Benefits
2.1   Diseases of Veterans Who Served In Vietnam
2.2   Diseases of the Children of Male Veterans of Vietnam
2.3   Diseases of the Children of Female Veterans of Vietnam
2.4   Post Traumatic Stress Disorder, PTSD
3.0  Special Benefits Consideration
3.1   The Veteran
3.1a  Earlier Claims
3.1b  The Need to Reopen Claims
3.1c  Concurrent Pay
3.2  Spouse Benefits:  Why these Spouses are Unique
3.2a  Compensation 
3.2b  Education
3.2c  Preference Points 
3.2d  Health Care 
3.2e  Other Benefits
3.3  Children
3.3a  Compensation 
3.3b  Education                                                                                                                           
3.3c  Health Care  
3.3d  Special Considerations 
4.0  Agent Orange Details                                                                                                          
4.1  Agent Orange Registry                                                                                                             
4.2  Agent Orange Lawsuit
4.3  Agent Orange   HOT LINE
4.4 Agent Orange 2007 Updates
5.0  Other Details
5.1  Diabetes and Sight Loss                                                                           
5.2  Reflections on PTSD
5.3  CFR Citation (on herbicides)
5.4  Comments on Applying for Service Connection
1.0  Introduction
As we move past the thirty-year anniversary of the end of the Vietnam era there are still lingering health problems for many of the veterans from that era.  The following document looks at Agent Orange exposure and the diseases and benefits linked to Agent Orange. 
Agent Orange exposure covers the veterans who were in country from January 9, 1962 to May 7, 1975.  Veteran exposed in 1968 and 1969 in Korea are also covered in this document (see explanation below).  In 2006 the Department of Defense, DoD provided a partial list of other locations where Agent Orange has been used.  The list is available on request, or can be found on the VA’s Agent Orange homepage at:
The specific list can be found at:
1.1  Brief History of Agent Orange Use and Follow on Health Studies
During the war in Vietnam the military used chemical agents to do away with the jungle vegetation.  At the time of use no one realized that this could have harmful effects on humans.  The chemicals were shipped in barrels with coding stripes.  Agent Orange comes from the orange stripes on the barrels.
After the war the Air Force was tasked to do follow up studies on the effects on chemical on the troops.  Three studies were done and the results were very controversial.  By the mid 1990’s it was clear that Vietnam veterans were having health side effects due to Agent Orange exposure.
Studies continue on the effects of Agent Orange.  In 2002 Type 2 diabetes was Service Connected to Agent Orange.  In 2003 a form of Leukemia was also linked to Agent Orange exposure.  Children of veterans who served in Vietnam (and Korea in 1968 and 1969 near the DMZ) could also be service connected for birth defects.  This was the first time offspring of veterans had ever been considered for their own direct service connected benefits.
In 2005 studies reconfirmed the link between Agent Orange and type 2 Diabetes.  However, findings in other areas were inconclusive.  Go to section 4.4 for more recent updates on Agent Orange.
2.0  Agent Orange and Service Connected Benefits
One day in country during the war constitutes exposure to Agent Orange.*  This is not always as clear as it may sound.  Many veterans of the Navy never went ashore, though they were in the waters around Vietnam.  Other veterans were never acknowledged to be in Vietnam due to the nature of the units they served in.  This can make proving a claim very difficult.
The Department of Defense has announced that Agent Orange was used in Korea in 1968 and 1969 along the demilitarized zone (DMZ).  Veterans who served along the DMZ in those years are encouraged to put in claims.
There are other locations where the Defense Department acknowledges Agent Orange use.  The VA has asked for more information from DOD to help expand eligibility for claims from other locations.
* In 2006 this definition of service in Vietnam was set aside by the Court of Veterans Appeals, COVA.  COVA did not offer a new definition, but felt that this was too narrow a definition because it excluded Navy personnel potentially exposed.  At the time of this going to press the VA has apparently decided to narrowly define Agent Orange exposure in a way that may exclude personnel who served off the shore of Vietnam.
We are recommending that all Navy personnel who have a Vietnam Service Medal, VSM, to apply for service connection if they have one of the presumptive conditions linked to Agent Orange exposure (see below).  As part of your claim we recommend including documentation of your VSM.  Unless, something changes in the near future, the claim will be turned down, but in the future would be covered under Nehmer (see explanation in Section 3.1a) if the VA reverses its rules on exposure.
2.1  Diseases of Veterans Who Served In Vietnam
Chloracne: a skin condition that looks like common forms of acne. It is important to mention that skin disorders are among the most common health problems experienced by combat forces. Because of the environment and living conditions in Vietnam, veterans developed a variety of skin problems, ranging from bacterial and fungal infections to a condition known as "tropical acne". However, the only condition consistently reported to be associated with Agent Orange and other herbicides is chloracne.
Non-Hodgkins Lymphoma: a term used to describe a group of malignant tumors that first affect the lymph glands and other lymphatic tissue. These tumors are relatively rare (about 3% of all cancers that occur among the U.S. general population) and, although the survival rate has improved considerably over the last 20 years, these diseases tend to be fatal.
Soft Tissue Sarcoma: a group of different types of malignant tumors which arise from body tissues such as muscle, fat, blood and lymph vessels and connective tissues; and distinctive from hard tissue such as bone or cartilage.
Peripheral Neuropathy: a nervous system condition that causes numbness, tingling, and muscle weakness by involvement of the nerves; that is, neural conducting tissue outside the brain and spinal cord.
Hodgkin’s Disease: a malignant lymphoma characterized by progressive enlargement of the lymph nodes, liver, and spleen, with progressive anemia.
Porphyria Cutanea Tarda: a disorder characterized by thinning and blistering of the skin in sun-exposed areas.
Multiple Myeloma: a cancer of specific bone marrow cells or the plasma cell and characterized by plasma cell tumors in various bones of the body.
Respiratory Cancers: this refers to cancers of the lung, larynx, and bronchus.
Prostate Cancer: prostate cancer is the most common cancer (excluding skin cancer) for American men. The National Academy of Science concluded, in its most recent report, that Vietnam veterans have an even greater increased incidence rate for contracting prostate cancer as a result of exposure to Agent Orange.
Adult Onset Type II Diabetes Mellitus: high blood sugar, resulting from a deficiency of insulin, a hormone produced by the pancreas. When the body doesn't produce insulin, or doesn't use it correctly, it can't make use of its main fuel -- sugar. Untreated, diabetes can lead to blindness, vascular disease, kidney disease, neuropathy, and other problems.
Chronic Lymphocytic Leukemia (CLL): CLL is a progressive disease that involves increased production of white blood cells.  The chance of recovery from CLL largely depends on the stage of patient’s health. 
CLL was declared service connected in January of 2003 and is the most recent of the service connected conditions linked to Agent Orange veteran diseases.
2.2  Diseases of the Children of Male Veterans of Vietnam
Spina Bifida: a devastating spinal birth defect that affects the children of some Vietnam veterans. 
For more information on Spina Bifida benefits go to:
For a short time period Acute myelogenous leukemia was considered a disease of the offspring of Agent Orange veterans.  This has since been rescinded based on new scientific research.
 2.3  Diseases of the Children of Female Veterans of Vietnam
Achondroplasia (produces a type of dwarfism)
Cleft palate and cleft lip
Congenital heart disease
Congenital talipses equinovarus (clubfoot)
Esophageal and intestinal artesia
Hallerman-Streiff syndrome (prematurity, small growth and other defects)
Hip dysplasia
Hirschprung’s disease (congenital megacolon)
Hydrocephalus due to aqueductal stenosis
Hypospadias (abnormal opening in the urethra)
Imperforate anus
Neural tube defects
Poland syndrome (webbed fingers and other birth defects)
Pyoric stenosis
Syndactyly (fused digits)
Tracheoesophageal fistula
Undescended testicles
Williams syndrome (linked to thyroid activity, multiple defects)
NOTE:  In December of 2003 these same service connections were extended to the children of veterans who served at the DMZ in Korea in 1968 and 1969.
For more information on benefits for children of female veterans exposed to Agent Orange go to the following website:
2.4  Post Traumatic Stress Disorder, PTSD
PTSD is not caused or linked to Agent Orange.  Estimates of PTSD for Vietnam veterans run as high as 30%.  PTSD can have devastating affects on  the veteran and  the family.  It may make convincing the veteran to attend or participate in rehab services very difficult.
Newer treatments for PTSD seem to work.  They involve medications.  It can be a challenge for the veterans to take medications regularly.  (See section 5.2 below for more on PTSD).
3.0  Special Benefits Consideration
To establish a service connected claim based on exposure to Agent Orange a veteran has to demonstrate being in country (Vietnam) for at least one day.  The same is true of the DMZ in Korea.
 3.1  The Veteran
Most of the items linked to Agent Orange exposure no longer have time windows for application for service connection.  This was reaffirmed in 2004 by an Institute of Medicine’s study on the cancers linked to Agent Orange.  A person can apply for service connection for the remainder of their life.  The exception would be peripheral neuropathy, which would have to show up within one year.  However, if the veteran had diabetes that was service connected, the form of peripheral neuropathy connected to diabetes could be linked as a secondary effect of the diabetes.
One question some individuals have is:  If some people would have developed diseases such as diabetes or prostate cancer anyways, why service connect them?
It is true that in a group of veterans statistically some would develop diabetes and prostate cancer.  Research has shown that the rate was higher in Vietnam veterans or that exposure to certain chemical agents definitely can cause certain diseases.  Also, there is a chance that Agent Orange contributes to much more severe cases of the disease.  This last point is not a proven scientific point, but a nasty possibility. 
Editor's Note: A recent study by the Department of Defense suggested that the recurrence of prostate cancer is more likely for individuals exposed to Agent Orange.
Claims for Agent Orange are handled just like other claims.  The veteran needs a diagnosis and medical proof.  They must also show that they were in Vietnam for one day.  If their DD 214 does not make this clear, or their unit was not assigned to Vietnam, then the veteran may need statements to show that they were in Vietnam.
3.1a  Earlier Claims
A number of veterans applied for service connection, especially for type 2 diabetes prior to diabetes being recognized as linked to Agent Orange.  Due to court decisions the VA must go back and recognize those (and other Agent Orange) claims from the initial filing. 
This decision is a result of a 13 year long series of class action suites against the VA.  The person listed in the suite was Beverly Nehmer, and the resulting action is known as “Nehmer”.  Under the Nehmer clause three principles came out:
A person could receive back pay to the original date of a claim
A person could not receive interest on the back pay
The estate of a person could receive benefits under this principle.  This might include back pay and the right to benefits such as Dependency Indemnity Compensation
Editor’s Note:  A veteran might consider applying for service connection for certain conditions such as cancers that are not currently recognized as being presumptive with Agent Orange.  The thought is that they might be service connected in the future.
3.1b  The Need to Reopen Claims
The term 100% sounds final.  A solution cannot be anymore than 100% of some one thing.  Often veterans do not understand that there are levels of 100% beyond the basic rating.  They do not understand the need to reopen their claim and document additional disabilities.
What is the benefit in reopening claims? 
First, it allows the possibility of special monthly compensation.  This could mean additional dollars.
Second, when a claim involves vision it may trigger a benefit such as Auto Grant, or Special Housing Grant, which is a large lump sum payment towards an auto or housing modifications.
Third, if a veteran is not rated Permanent and Total it important to work towards this rating, and to document potential conditions that could cause death.  Payments from the VA to the spouse and family might hinge on dying of service connect cause or being rated Permanent and Total for a certain time period.
Finally, a rating that leans more heavily towards Agent Orange related items may have an effect on a military retirees rate of Combat Related Special Compensation (see below).
3.1c  Concurrent Pay
Concurrent Pay has been undergoing evolution since 2003.  The National Defense Act of 2008 called for some additional changes in CRSC (see below).
There currently are two types of Concurrent Pay:
Veterans who served 20 years in the military are eligible for Concurrent Receipt of their retirement pay in addition to their VA compensation if they fall into one of the following categories:
CRDP- Concurrent Retirement and Disability Payments, which is paid to individuals with 50% service connection or higher.  To receive CRDP an individual must have served 20 years on active duty. 
CRSC -  Combat Related Special Compensation, which is paid for any battlefield related injury 10% or higher for which the veteran is receiving compensation.  The veteran must apply for this through their branch of service. 
The National Defense Act of 2008 included provisions for Chapter 61 retirees (those who were medically retired before 20 years) if there injuries were combat related.  It also called for adjustments for those veterans who were on Individual Unemployability dating back to January 2005.  Details on these changes had not been released at the time this edition went to press.
All of this has become very complicated.  CRDP is granted automatically to a retiree through joint cooperation by DoD and the VA.   A veteran must apply for CRSC.  To apply the veteran must fill out a DD 2860.   An individual does not collect both CRDP and CRSC, they collect whichever is of greater value. 
For more information on CRDP the veteran would contact Defense Finance and Accounting Service at:  1800 321 1080
Or write:
Defense Finance and Accounting Service
Cleveland Center
Retired Pay Department (FRCCBB)
PO BX 99191
Cleveland, OH 44199-1126
To apply for CRSC the DD 2860 is submitted through their branch of service.  They may also contact their service branch for more information on CRSC and eligibility.  The following is current contact information:
Department of the Army
U.S. Army Physical Disability Agency
Combat-Related Special Compensation (CRSC)
200 Stovall Street
Alexandria, Virginia 22332-0470
Toll-free: (866) 281-3254
Hours: 8am - 8pm EST
E-mail your questions to:
Or visit:
Department of Navy Naval Council of Personnel Boards
Combat-Related Special Compensation Branch
720 Kennon Street S.E., Suite 309
Washington Navy Yard, DC 20374-5023
(Toll free 1-877-366-2772)
United States Air Force Personnel Center
Disability Division (CRSC)
550 C Street West, Suite 6
Randolph AFB, TX 78150-4708
(Toll Free 1-866-229-7074)
Commanding Officer (RAS)
U. S. Coast Guard Personnel Service Center
444 SE Quincy St.
Topeka, KS 66683-3591
(toll-free at 1-800-772-8724)
All CRSC payments are tax exempt.  It is considered a disability type payment, not a retirement payment.  This has large implications for tax purposes.
The definition of battlefield injuries falls into two categories.  The first is direct injury, the type Purple Hearts are awarded for.  The second is conditions or injuries linked to battlefield action.  This would cover Agent Orange exposure and possibly PTSD if it could be linked to combat. 
Concurrent Pay for Spouses
Spouses of military retirees have three possible government retirement sources to consider:
Social Security
Survivor Benefits Plan, SBP
Dependency Indemnity and Compensation, DIC
SBP is an annuity that the veteran pays into so that the surviving spouse can receive a percentage of their military retirement pay. 
For more information on SBP go to:
DIC is paid by the VA.  It is for the survivors of a service connected veteran if the death met one of the following conditions:
       Military service member who died while on active duty, OR
1       Veteran whose death resulted from a service-related injury or disease, OR
2       Veteran whose death resulted from a non service-related injury or disease, and who was receiving, or was entitled to receive, VA Compensation for service-connected disability that was rated as totally disabling
       for at least 10 years immediately before death, OR
1       since the veteran's release from active duty and for at least five years immediately preceding death, OR
2       for at least one year before death if the veteran was a former prisoner of war who died after September 30, 1999.
For more information on DIC go to:
Originally there were monetary offsets for individuals who eligible for Social Security, SBP and DIC.
As of 2005 a widowed spouse or a military retiree was able to collect Social Security and the Department of Defense’s Survivor Benefit Plan, SBP.  The SBP payment and full Social Security will be phased in increments from 2005 to mid year 2008.  Many retirees have dropped SBP, it is important to check on open seasons for re-entry into the program and cost for buy backs. 
It appears that the first SBP – DIC  payment offset will appear in 2008 as part of the provisions in the National Defense Act.  The sum of money is small.  Though it is not officially labeled as an offset and at this time there are no plans for further increases, it may be the start of the removal of the SBP-DIC offset.
It appears that there will be a 50 dollar offset monthly starting in October of 2008.  With a 10 dollar a month increase for the next 5 years.  Final details on this were not available at the time this went to print.
3.2  Spouse Benefits:  Why these Spouses are Unique
For many years the VA has been predominantly World War 2 veterans.  This is not good or bad, but merely a reflection of the large number of people who served during that war.
Today, when a World War 2 veteran dies it is a fairly safe bet that the spouse is of retirement age.  Talk about going to school and rejoining the workforce is not really the core element of the benefits used.  We normally speak in terms of benefits such as Dependency Indemnity Compensation.
Agent Orange veterans may be as young as their 50’s.  You may have cases where the veteran was working only months before and was forced to quit due to health.  Health care for the spouse may have been made available through the veteran’s job.  The spouse may be well below Medicare age and find for the first time in decades they find themselves with no health insurance.
NOTE:  In the review of benefits below we are talking in terms of the veteran being 100% service connected.  It could be due to Unemployability or Permanent and Total type rating that is clearly 100%.
3.2a  Compensation
The spouse will receive no compensation as long as the veteran is alive.  However, the veteran will draw compensation.  When the veteran dies the spouse could be eligible for Dependency Indemnity Compensation.  It is important that they understand the program.  This program has Housebound and Aid and Attendance rates also, a fact that few spouses understand.
3.2b  Education
The granting of 100% service connection or death from a service connected cause can open a window of education benefits for the spouse.  The loss of income from the veteran’s job could make education a consideration.
NOTE:  Eligibility for education benefits is opened once for a ten year period.  If it opens upon granting of 100%, it does not reopen later if the veteran dies of a service connected cause later.  If a veteran rated less then 100% dies of a service connected cause the education window will open for the first time for the spouse.
3.2c  Preference Points
A spouse can apply through Regional Office to use the veteran’s preference points in the event the veteran is no longer able to work due to a service connected disability rated at 100%.  Again, if the spouse finds that they are back in the workforce, or the major breadwinner this could be an important consideration.
3.2d  Health Care
The spouse may be eligible for CHAMPVA as a health care provider.  This could be critical if there is no other health care in the family.  CHAMPVA is now an extended benefit that can be used past Medicare age in the CHAMPVA for Life program.  
The spouse of a military retiree is likely to be covered by the TRICARE health program and ineligible for CHAMPVA.
3.2e  Other Benefits
With the granting of 100% service connection comes PX and Commissary privileges.  There are other perks and privileges that are linked to being rated 100% service connected many have to do with use of Department of Defense facilities.
3.3  Children
Children of Vietnam veterans are going to find that they are in one of two categories:
The vast majority will receive benefits through their veteran parent.  This includes additional compensation for a dependent, health care, and education benefits.  For many this will end when they reach 18.  For some it will continue through their post high school education years, and end when their education is completed.  For a few who have severe disabilities before the age of 18, they may remain the dependent of the veteran for life, and collect Dependency Indemnity Compensation when the veteran dies.
The second group of children have health conditions that are linked to the veteran’s exposure to Agent Orange.  These children are themselves service connected and have their own benefits.  For this second group of children the following benefits exist:
3.3a  Compensation
Compensation is not paid at the same rate as a veteran’s compensation.  A separate tiered scale is used.  Application for benefits are is made through Regional Office following the normal criteria for evidence.
3.3b  Education
A child in this category will receive the same education benefits that a dependent child eligible for VA education benefits would receive.
3.3c  Health Care
These children will be eligible for health care funded by the VA for life.
3.3d  Special Considerations
Would a service connected child with spina bifida be eligible for Blind Rehab services from the VA?  
This has not been tested – yet.  It is my guess that they would be eligible for this service if they wished to pursue it.  But, there is no precedence in such a case.
4.0  Agent Orange Details
4.1 Agent Orange Registry
Vietnam veterans and veterans from Korea who served in the DMZ area can be tested and placed on the Agent Orange Registry.  What does this mean in practical terms?
The registry is a database used for health care comparisons.  It is vital in research, but not in the individual’s claim process.  This might sound confusing, but here is a practical example:
Diabetes was shown to be service connected by doing a comparative study between veterans who served in Vietnam and those who did not, all having served in the same time frame.  The VA can use the registry for statistical information for Vietnam veterans.  A veteran is doing a great service research wise by going through the registry process.
EDITOR'S NOTE:  The findings of a Registry exam can be used in the claim process as evidence.  This is information in the VA system and easy to access by VA Regional Office.
4.2 Agent Orange Lawsuit
A class action suit was filed in 1979 on behalf of Agent Orange exposed veterans against the chemical companies that had produced Agent Orange.  The suit was settled in 1985 and paid approximately 180 million dollars to 50,000 veterans.  Well over 2 million veterans were exposed to Agent Orange.
4.3  Agent Orange   HOT LINE:  1 (800) 749 8387
The VA sends out a quarterly bulletin on Agent Orange.  It is called Agent Orange Review.  A veteran can enroll for the bulletin by calling the hotline. The hot line will also answer questions and provide information.
4.4 Agent Orange 2007 Updates
The year 2007 proved to be a very busy one for Agent Orange concerns.  However, is some areas there seem to be more questions then answers.
Navy Service off Vietnam coast:  At the time of printing there has been no formal resolution of what constitutes exposure for personnel serving off the shore of Vietnam.

Agent Orange use in Guam and Okinawa:  It came to light from two already decided cases that Agent Orange was used in some manner on Guam and Okinawa and that individuals were granted service connection by the Board of Veterans Appeals.  Neither Okinawa or Guam were included on the DoD list offered on sites where Agent Orange was used.    The website below also covers a case in Thailand.  DoD has already released that certain areas of Thailand were sprayed.  However, this case hinged on an individual who worked on the equipment used to spray Agent Orange as his exposure.

To review these cases go to:
Agent Orange has long been rumored to have been used at Panama and Johnston Island.  This has never officially been confirmed.
In July of 2007 a report came from the Institute of Medicine of a possible link between Agent Orange exposure and high blood pressure.  No further considerations have come out on this yet.
5.0  Other Details
5.1  Diabetes and Sight Loss
One of the earliest symptoms of diabetes can be blurred vision.  This blurred vision can be caused by the lens of the eye swelling in response to high blood sugar.  This is not permanent and goes away when blood sugar is in control.
Vision may be affected when a person is in very low blood sugar.  The field of vision may actually narrow.  Low blood sugar has other serious affects including influencing judgment.  A person may not even realize they are in low blood sugar and do nothing to correct it.  Low blood sugar can lead to the loss of consciousness and even more serious complications.
But, these are not the long-term effects of diabetes on vision.  The blood vessels in the back of the eye and in the kidneys are some of the very finest in the body.  Blood vessels high in glucose content are rigid and over time tend to damage these blood vessels.  They leak and cause fatty deposits on the Retina.  These are referred to as cotton-wool spots (because of their appearance).
Blood vessels can actually start to break and cause bleeding into the eye.  In most cases the intervention of choice to stop bleeding has been the use of a laser.  Though the laser effectively stops bleeding portions of the retina are damaged and there is permanent vision loss.
The body in an attempt to adjust might promote the growth of new blood vessels.  These tend to be frail and break easily creating additional bleeding.  Many of the new treatments that involve injections and medication implants are to address the problem of new blood vessel growth and the additional problems they bring.
The best intervention the individual can do to save their eyesight is effective control of your blood sugar.  This is done through diet, medications, stress reduction, and exercise.
Everyone with diabetes should be doing regular finger sticks (using a glucometer).  Large print or a talking glucometers are options for visually impaired individuals.
Progression of Medications
Individuals with diabetes usually have a medications treatment that follows something like this:
Exercise and Meal Planning with the goal of possible weight loss
Diabetes Pills
Multiple Pills used together
Insulin added to pill therapy
Increased insulin dose and frequency if shots
NOTE:  Diabetes is a cause of one type of Glaucoma.  This type involves the growth of new blood vessel growth and may be referred to as neo-vascular.  It is important to have this type defined if the veteran is going to reopen a claim based on glaucoma and diabetes service connection.
5.2  Reflections on PTSD
The National Comorbidity Survey Report (NCS) provided the following information about PTSD in the general adult population:
The estimated lifetime prevalence of PTSD among adult Americans is 7.8%, with women (10.4%) twice as likely as men (5%) to have PTSD at some point in their lives. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The most frequently experienced traumas were:
Witnessing someone being badly injured or killed
Being involved in a fire, flood, or natural disaster
Being involved in a life-threatening accident
Combat exposure
The majority of the people in the NCS experienced two or more types of trauma. More than 10% of men and 6% of women reported four or more types of trauma during their lifetimes.
The traumatic events most often associated with PTSD in men were rape, combat exposure, childhood neglect, and childhood physical abuse. For women, the most common events were rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.
However, none of these events invariably produced PTSD in those exposed to it, and a particular type of traumatic event did not necessarily affect different sectors of the population in the same way.
The NCS report concluded that "PTSD is a highly prevalent lifetime disorder that often persists for years. The qualifying events for PTSD are also common, with many respondents reporting the occurrence of quite a few such events during their lifetimes."
The National Vietnam Veterans Readjustment Survey (NVVRS) report provided the following information about PTSD among Vietnam War veterans:
The estimated lifetime prevalence of PTSD among American Vietnam theater veterans is 30.9% for men and 26.9% for women. An additional 22.5% of men and 21.2% of women have had partial PTSD at some point in their lives. Thus, more than half of all male Vietnam veterans and almost half of all female Vietnam veterans-about 1,700,000 Vietnam veterans in all-have experienced "clinically serious stress reaction symptoms."
15.2% of all male Vietnam theater veterans (479,000 out of 3,140,000 men who served in Vietnam) and 8.1% of all female Vietnam theater veterans (610 out of 7,200 women who served in Vietnam) are currently diagnosed with PTSD. ("Currently" means 1986-88 when the survey was conducted.)
The NVVRS report also contains these figures on other problems of Vietnam veterans:
Forty percent of Vietnam theater veteran men have been divorced at least once (10% had two or more divorces), 14.1% report high levels of marital problems, and 23.1% have high levels of parenting problems.
Almost half of all male Vietnam theater veterans currently suffering from PTSD had been arrested or in jail at least once-34.2% more than once-and 11.5% had been convicted of a felony.
The estimated lifetime prevalence of alcohol abuse or dependence among male theater veterans is 39.2%, and the estimate for current alcohol abuse or dependence is 11.2%. The estimated lifetime prevalence of drug abuse or dependence among male theater veterans is 5.7%, and the estimate for current drug abuse or dependence is 1.8%.
For more information you can go to the following Website:
5. 3  CFR Citation
The following is the section of the 38 CFR 3.309, Disease subject to presumptive service connection that covers Agent Orange exposure.  It is important to not that findings on Agent Orange are changing faster than the law.  Those changes are addressed through memorandums from the Secretary of the Veterans Administration.
(e) Disease associated with exposure to certain herbicide agents. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 3.307(d) are also satisfied.
        Chloracne or other acneform disease consistent with chloracne
        Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes)
        Hodgkin’s disease
        Multiple myeloma
        Non-Hodgkin’s lymphoma
        Acute and subacute peripheral neuropathy
        Porphyria cutanea tarda
        Prostate cancer
        Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea)
Soft-tissue  sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)
Note 1: The term soft-tissue sarcoma includes the following:
        Adult fibrosarcoma
        Dermatofibrosarcoma protuberans
        Malignant fibrous histiocytoma
        Epithelioid leiomyosarcoma (malignant leiomyoblastoma)
        Angiosarcoma (hemangiosarcoma and lymphangiosarcoma)
        Proliferating (systemic) angioendotheliomatosis
        Malignant glomus tumor
        Malignant hemangiopericytoma
        Synovial sarcoma (malignant synovioma)
        Malignant giant cell tumor of tendon sheath
Malignant schwannoma, including malignant schwannoma with rhabdomyoblastic differentiation (malignant Triton tumor), glandular and epithelioid malignant schwannomas
        Malignant mesenchymoma
        Malignant granular cell tumor
        Alveolar soft part sarcoma
        Epithelioid sarcoma
        Clear cell sarcoma of tendons and aponeuroses
        Extraskeletal Ewing’s sarcoma
        Congenital and infantile fibrosarcoma
        Malignant ganglioneuroma
Note 2: For purposes of this section, the term acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset. 
5.4 Comments on Applying for Service Connection
There is now a clearly established precedent for applying for service connection for exposure to Agent Orange in Vietnam or Korea.  However, it is clear that individuals have been exposed to Agent Orange at other locations throughout the world.  How should a veteran approach those claims?
It seems clear that the burden of showing a logical exposure from the cases in Guam, Okinawa, and Thailand demonstrate that just being in country is not the key to winning the case.  The individual has to show how their activity brought them in contact to areas where Agent Orange was used, or in contact with Agent Orange equipment used for spraying.
Consider this in writing your claim.  If you worked on the flight line and the perimeter was cleared by Agent Orange use, you may have a possible claim.  If you jogged on Guam, then you need to include where you jogged and how you now know it was in or near the area that Agent Orange was used to clear the flight line or fields.  Being in Guam alone will not win your case.
Consider using statements of witnesses.  There may be people from you unit that can corroborate that Agent Orange was used to clear the fields.
It is highly recommended that you submit copies of the existing Board of Veteran Appeals cases (see website below) as part of your evidence.  Also, reading them, might provide you insight as to if you have a valid claim.
It is also highly recommended that you file, even if your exposure was in areas such as Panama and Johnston Islands.  These are locations that DoD has never indicated that Agent Orange was used.  Under Nehmer, you would be establishing the date of your original claim.
Finally, it is recommended that you seek the assistance of a service organization in filing.  These cases are not likely to be settled at Regional Office.  They may need to be appealed and move up the ladder.  Representation is a good thing to have.

Pentagon Channel Sheds Light on PTSD
American Forces Press Service | David Mays | November 03, 2006
WASHINGTON - The Pentagon Channel is taking an in-depth look at post-traumatic stress disorder in a new edition of its monthly documentary “Recon.” The half-hour show, called “The Wounds Within,” explores how the understanding of PTSD has evolved from the Civil War to World Wars I and II to Vietnam and now to operations Enduring Freedom and Iraqi Freedom.

It also demonstrates how the Department of Defense is aggressively treating servicemembers returning from battle today, Pentagon Channel officials said.

“It’s not a small problem,” said Air Force Master Sgt. Daniela Marchus, who hosts the show. “Seeking help is such an important thing.”

Former Marine David Powell is featured in “The Wounds Within.” He was shot outside Danang, Vietnam, in 1968. “I saw the track of the bullet pass through the flak jacket of the fellow in front of me, and it was as if someone was pulling a thread,” Powell said. “The recall is vivid beyond imagination.”

Powell returned from battle with a Purple Heart but limited treatment options. “There was no decompression,” he said. “You were one thing: a combat veteran trying to save your own life.”

Army Pfc. Brian Daniels also is profiled in this program. His right leg was severely injured when a roadside bomb rocked his Humvee in Iraq. “I remember the smell, the sound,” he said. “It seems like it was yesterday.”

Unlike his counterparts wounded in Vietnam, Daniels was diagnosed with PTSD and quickly offered counseling.

“In the Civil War it was called ‘nostalgia’; following World War I it was called ‘shell shock’; following World War II it was called ‘combat fatigue’,” Dr. Robert Ursano of the Uniformed Services University of the Health Sciences told “Recon” producers. “There’s always been a name, but never as much focus and trying to understand and intervene.”

But even with today’s understanding and treatment, “The Wounds Within” shows why many servicemembers refuse to seek help.

“There’s a stigmatization of mental health,” said Army Lt. Gen. Kevin Kiley, the service’s surgeon general. “It’s a challenge to break through the stigma.”

Many other wounded servicemembers share very personal stories of how they survived, how they were able to seek treatment and how they are coping today in this emotionally charged “Recon.”

Marchus said she hopes “The Wounds Within” will spark discussion about PTSD and prompt servicemembers who are suffering in silence to ask for help. “They are suffering emotionally,” she said. “They are not alone.”

“Recon: The Wounds Within” premiers tomorrow at noon Eastern on the Pentagon Channel. It will encore throughout the month.


Please press the next link to watch a brief video and/or read an article on Project Compassion.


Military Psychiatric-Care Overhaul Urged

Washington Post Staff Writers
Tuesday, June 19, 2007; Page A07

Top officials in the Bush administration and on Capitol Hill said yesterday that the federal government must move quickly to revamp the nation's system for identifying and caring for military personnel with the invisible wounds of mental illness.

Acting Army Secretary Pete Geren visited Walter Reed Army Medical Center yesterday and discussed mental-health issues, including treatment for patients with post-traumatic stress disorder (PTSD) on Ward 53, according to an Army spokesman.

"We have realized there are shortfalls, and we've been going about fixing it," said Col. Dan Baggio, noting that the Army has conducted four mental-health surveys of soldiers in Iraq and Afghanistan.

Geren, whose Senate confirmation hearing is scheduled for today, regularly visits Walter Reed. The previous Army secretary, Francis J. Harvey, resigned after Washington Post articles published in February revealed poor living conditions and bureaucratic obstacles for wounded soldiers at Walter Reed. Over the past two days, The Post has published stories detailing the bureaucratic and health difficulties of troops returning home with PTSD.

Defense Secretary Robert M. Gates "is very concerned that we're doing everything possible for the wounded warriors as they return, not just the physical wounds but the psychological trauma," said Pentagon spokesman Bryan Whitman.

The Army is hiring 200 more psychiatrists, psychologists and social workers to help soldiers with mental-health problems, and next month it will launch an educational program on stress for all soldiers and commanders, said Maj. Gen. Gale S. Pollock, the acting surgeon general of the Army.

The Army is also expanding a pilot program at Fort Bragg to offer behavioral-health treatment at primary-care facilities to reduce the stigma for soldiers seeking care, Pollock said.

"The tragic cases of combat stress discussed in the Washington Post June 17-18 are powerful and concerning to the U.S. Army," Pollock said in a statement. She emphasized that the Army is continuing to address the problems of soldiers with PTSD, including placing hundreds of mental-health specialists on the battlefield in Iraq and Afghanistan to counsel soldiers with combat stress.

Pollock cited efforts such as post-deployment health assessments, begun in 1998. Based on a 2004 study by Walter Reed researchers, the Army added a second screening for soldiers a few months after their return to catch problems that are not quickly apparent, such as PTSD.

Veterans Affairs Secretary Jim Nicholson on Sunday telephoned former Army Spec. Jeans Cruz of New York, who was profiled in the Post series.

Cruz, who helped capture Saddam Hussein, has been plagued by anxiety and nightmarish images of dead Iraqi children since returning home. Yet VA has denied his claim for compensation, ruling that his psychological problems existed before he joined the Army and that he had not proved that he saw combat.

"The secretary did call on Sunday, and there is an immediate review of that case going on," said Lisette Mondello, a VA spokeswoman.

According to Cruz, VA officials told him that a records search yesterday had confirmed that his Army Commendation Medal With Valor -- awarded for his help in catching the Iraqi leader -- had been left off his records. Cruz said he was told that his application for disability compensation would be reopened and expedited.

VA officials said they are aware of the growing PTSD problem. Last week, for instance, Nicholson directed the department's 153 medical centers to extend their hours to ensure that veterans can reach VA's more than 9,000 mental-health professionals when they need them.

This month, William F. Feeley, VA's deputy undersecretary for health, directed top department officials to implement new mental-health initiatives by Aug. 1, including a requirement that all veterans asking for mental-health or substance-abuse care be evaluated within 24 hours.

"The VA takes its role as the leader in mental health in this country very seriously," Mondello said.

Lawmakers in Congress also noted the PTSD crisis.

"Certainly you need a whole new attitude from the top leadership on mental health," said Rep. Bob Filner (D-Calif.), chairman of the House Committee on Veterans' Affairs. Military leaders "have got to say, 'It's okay to admit this and get treated for it. It's not going to affect your promotions.' "

Sen. Daniel K. Akaka (D-Hawaii), chairman of the Senate Committee on Veterans' Affairs, said the committee is scheduled to consider legislation next week that would extend automatic health-care coverage for combat veterans to five years, up from two, so they can receive treatment for mental illnesses that can take years to surface.

A congressionally mandated Pentagon mental-health task force issued a report with 90 recommendations on Friday, and Rep. John M. McHugh (R-N.Y.), who was involved in establishing the panel, said he is hopeful that the Pentagon "will use the task force findings to straighten this ship up and do a better job."

Rep. Susan A. Davis (D-Calif.), a member of the House Armed Services Committee, said she is encouraged that the Pentagon report called for overhauling the system of care for mentally wounded service members. "They seem to take the issue for what it is, which is a need to transform the way we respond," said Davis, who has introduced legislation to create two Defense Department centers dedicated to understanding and treating military mental health.


7,688 Total Members in a Yahoo Email Group  -  PTSDveteranSupport War_Zone_Related_Stress_Reactions

99.7% Vote  - There Should Be A Federal PTSD Veterans Advocacy Agency.

The poll is still active.

You can visit or join the group at:

Almost 4,000 members have voted in our poll.   The results so far should be giving our federal government a message that we are asking for a federal PTSD disabled Veterans Advocacy agency.   Please support Disabled PTSD Veterans' Civil Rights with Reasonable Disability Accommodations.   Federal Politicians do not even answer our letters on the subject.
Harassing PTSD disabled veterans should be considered a hate crime and a crime of discrimination.


Please press the next link to watch a brief video and/or read an article on Project Compassion.


  Major signs and symptoms of PTSD in Vietnam veterans include helplessness, survivor guilt, anger, isolation and estrangement, low tolerance of frustration, severe loss of memory.  The unique aspects of these symptoms in medical personnel are described below.

HELPLESSNESS.  Many medical personnel still experience a feeling of pervasive helplessness because of the futility of their efforts to deal with an overwhelming wave of human casualties.  Often
coupled with this feeling of helplessness is a lingering
preoccupation with death, which is sometimes anifested in somatic symptoms.

SURVIVOR GUILT.  Interviews with several medics, corpsmen, and nurses indicate that the guilt common to many of the combat soldiers who served in Vietnam takes a special form with health personnel.  Despite the incredible and heroic lifesaving acts they performed almost daily, many are plagued by the feeling that what
they did was not enough.  This sense of inadequacy is often seen in those who performed triage duty, which carried with it the probably consequence that someone would die so that others might
live (5).  To react emotionally to that responsibility could
render one dysfunctional and incapable of performing essential lifesaving duties.  Becoming close to people could mean inevitable pain, since the probability of losing them would be high.  The implications for subsequent psychic numbing and emotional
distancing are evident.

ANGER.  Anger resulting from the Vietnam experience is probably the most common denominator among Vietnam veterans(6).  The degree of anger varied among members of the medical profession whom we
studied.  Some felt ill prepared for the experience and continue to blame the military for inadequate training.  Others felt the frustration of not being able to retaliate or vent frustration as some "grunts" (combat soldiers) were able to do.  Some were not authorized to carry weapons, despite the fact that a red cross was often a prime target.
  Anger also resulted from the fact that during their Vietnam experience nurses, corpsmen, and medics performed lifesaving techniques, including surgical procedures, that they were not permitted to perform when they returned to the States.  After
their return nurses often abandoned their profession in
disillusionment because they were not able to use the valuable experience gained from trauma medicine in Vietnam.  Medics discovered that they would have to undergo additional training to receive certification as emergency medical technicians.
  It is interesting to note that medical personnel seemed to feel less anger and resentment toward the Vietnamese people than did some Vietnam veterans.  That may be due to the fact that they had
more interaction with the Vietnamese culture on a personal basis through such activities as medical civilian action patrols.

ISOLATION AND ESTRANGEMENT.  Feelings of isolation and estrangement are especially prevalent among medical personnel.  Not only did they feel alienated from their society, like many other
returning veterans, but also from their peers.  A combat medic or corpsman solely responsible for between 12 and 20 men often felt uniquely alone, with no other medical personnel to share his experience.  Medics in combat vet rap groups describe feeling on the periphery of the group, since they were not considered combat
personnel.  "But I wasn't really in combat" or "I didn't see that much action" are not uncommon responses of medics, despite the revered role they held and the trauma they endured.  Their isolation may have been increased by such situations as being asked
for drugs by peers or to care for one soldier before another.
  Medical personnel rarely saw the result of their efforts.  Field medics often never knew if those they helped were alive, since they were quickly evacuated to other facilities.  Hospital personnel routinely performed patchwork surgery on soldiers, and the fruits of their labors often remained unknown to them.
  The physicians who served in Vietnam are a generally silent population.  It is probably safe to assume that they felt as isolated as or even more isolated than other health personnel.  Perhaps the omnipotence attributed to physicians makes it even more difficult for them to show human emotions.

LOW FRUSTRATION TOLERANCE.  Frequently a medic or corpsman who made split-second lifesaving decisions in Vietnam finds it difficult to make simple decisions ten years later.  The same people who performed admirably during round-the-clock medical
emergencies may have a low tolerance for frustration.  These problems may derive from a fear of failure or of taking risks, since making a mistake in Vietnam could literally mean the difference between life and death.

SEVERE LOSS OF MEMORY.  Memory loss relating to incidents occuring not only in Vietnam, but uncomfortable or painful moments throughout the veterans life is an all too common occurance.  Although these periods of amnesia are frequent, they are treatable through psycho-therapy and counseling with

  Although treatment techniques for PTSD do not differ for medical personnel and other veterans, any successful intervention with medical personnel requires a sensitivity to their unique experiences.
  It is possible that the premorbid personality of many members of the medical corps included a high sensitivity to human suffering.  This predisposition may increase the likelihood and severity of post traumatic stress disorder.  In addition, the initial idealism
of some helping professionals could compound the disillusionment they felt when they were confronted with the futility of their position.
  Therapists should be keenly sensitive to the sense of loss that these particular veterans feel.  For them the sense of loss is often compounded by the fact that they saw it as their duty to prevent loss and yet most likely experienced it the most(7).  As would be expected, grief work has proven effective with this population, as it has with other veterans.  Individual intervention can also be geared toward tapping and reframing (cognitive restructuring) the unique strengths they needed to
perform their responsibility in Vietnam.
  Involving medical personnel in a group with other Vietnam veterans can provide an opportunity for them to receive absolution from peers and can help reduce the isolation some have felt from their fellow veterans.  However, a homogeneous group, consisting
solely of those who served in caretaker roles, can be extremely effective and may be the ideal approach to take before involving medical personnel in a heterogeneous group with other combat vets.
  Above all, this group of veterans should be treated as
survivors, as has been suggested in working with all veterans(8). 
However, they should be viewed not only as survivors of a disaster, but also as the rescue workers who tried to help others survive.  Recent research has shown that rescue workers suffer much the same reaction as victims of a catastrophe because of the responsibility they bear for undoing the effects of the tragedy(9).  In civilian life, rescue workers are on the scene after the event.  However, in Vietnam some medical personnel were present during and after the catastrophe and had to maintain a high level of intensity throughout.  This intensity and duration combined to cause protracted stress.
  It is generally accepted that the severity of post traumatic stress disorder is proportionate to the level of exposure and intensity of stress.  It would seem that the exposure to trauma and the intensity of stress endured by medical personnel in Vietnam was extraordinary.  PTSD among these veterans takes special forms, combining the caretaker, combatant, and survivor
aspects of their experiences.


Suicide and Post-Traumatic Stress Disorder (PTSD)


Combat veterans, sexual assault survivors, and other victims of trauma are vulnerable to a condition called Post-Traumatic Stress Disorder (PTSD). People with PTSD suffer from a range of symptoms that interfere with their capacities to enjoy normal life.

People who suffered suicidal conditions, particularly conditions that were chronic, recurrent, or included one or more attempts, may also be victims of PTSD. According to its definition, PTSD may result when a person suffers an event or situation that is outside the range of normal experience, exceeds the individual’s perceived ability to meet its demands, and poses a serious threat to the loss of life.

Suicidal people meet the formal criteria for PTSD. Severe and prolonged suicidal pain is not something that most people suffer. People in suicidal crises feel that they are at the breaking point of what they can cope with. Since 30,000 people die by suicide each year in the United States, it is a condition that poses a serious threat to the loss of life.

Many of us are haunted by memories of acute crises, acts of self-injury, or extended periods of severe depression. Like citizens of a besieged city, we lived through periods of time in which we had a realistic and unrelenting fear that we would soon be dead. We suffer PTSD simply from having been suicidal, independently of whatever particular traumas may have contributed to our becoming suicidal, such as abuse during childhood or exposure to the violent death of someone else. Our “suicide PTSD” is also distinct from whatever traumatic events may happen as a result of being suicidal, such as involuntary hospitalization or job discrimination. Undoubtedly, most of us suffered many types of traumatic events in our lives, and these events and their consequences need to be addressed in recovery. But the suicidal crises themselves may be events that induce PTSD.

The PTSD literature for veterans and sex assault survivors lists conditions that are commonly found among survivors of those types of trauma. Survivors typically have only some of these symptoms, and the severity of a particular symptom may vary from individual to individual. Survivors of different types of traumatic events often have a different range of symptoms. A remarkably large number of these conditions are common among people with long-term histories of suicidal pain:

  • Problems with memory. Persistent, intrusive, and vivid memories concerning the traumatic situation. Events of daily life may trigger distressing memories related to the trauma. Memory lapses for parts of the traumatic situation. Many suicidal people are troubled by strong images, such as the feeling that they have bombs inside their bodies or a knife over their heads, and in recovery continue to be bothered by the memory of having had these images.
  • Avoidance of things associated with the traumatic experience.
  • Denial on the seriousness of the experience.
  • Persistent anxiety.
  • Fear that the traumatic situation will recur. The trauma is often an event that shatters the survivors’ sense of invulnerability to harm.
  • Disturbed by the intrusiveness of violent impulses and thoughts.
  • Engagement in risk-taking behavior to produce adrenaline.
  • A feeling of being powerless over the traumatic event. Anger and frustration over being powerless.
  • A feeling of being helpless about one’s current condition.
  • Being dramatically and permanently changed by the experience.
  • A sense of unfairness. Why did this happen to me?
  • Holding oneself responsible for what happened. Feeling guilty.
  • The use of self-blame to provide an illusion of control. Sexual assault survivors often blame themselves: “If I hadn't been at that location, worn those clothes, behaved in that way, then it wouldn't have happened.” This pattern is also found in the survivors of a completed suicide. “If I had only done x, the suicide would not have happened,” can be used to try to cope with the fear that suicide will happen again in the family--i.e., it is preventable if I just manage things differently. The suicidal are often full of self-blame. As in the other cases it is partly due to an internalization of social attitudes that blame the victim or family, and also due to the effort to gain mastery over the situation. To imagine we could have done more is more tolerable than total helplessness.
  • An inability to experience the joys of life.
  • Feelings of being alienated from the other people and society in general. “I am different. I am shameful. If they knew what I was like, they would reject me. I don't belong in this world. I'm a freak, an outcast.”
  • When people with PTSD try to return to normal life, they are plagued by readjustment problems in the basic elements of life. They have difficulties in relationships, in employment, and in having families.
  • A lack of caring attachments. A sense of a lack of purpose and meaning.
  • Some chronically traumatized people lose the sense that they have a self at all.
  • Veterans report the feeling that they never really made it back from the war. Formerly suicidal people feel they never really made it back to normal life.
  • One Viet Nam veteran with PTSD said, “I don’t have any friends and I am pretty particular about who I want as a friend.”
  • PTSD was aggravated for Viet Nam veterans because they returned to a country that had negative attitudes toward them. For sexual assault survivors, stigmatization is the “second injury”.
  • When Viet Nam veterans returned home people were angry at them. They had shamed the country, they had done something wrong, they were potentially harmful to others, it was dangerous to be with them. Sexual assault survivors may receive angry responses--on the grounds that they have done something that shames the family. Suicide attempters often experience great anger from family and care providers.
  • A deep distrust of co-workers, employers, authorities.
  • Left with unexpressed rage against those who were indifferent to their situation and who failed to help them.
  • In personal relationships there are problems of dependency and trust. A fear of being abandoned, betrayed, let down. A belief that people will be hurtful if given a chance. Feelings of self-hatred and humiliation for being needy, weak, and vulnerable. Alternating between isolation and anxious clinging.
  • Trauma often causes the victim to view the world as malevolent, rather than benign.
  • No sense of having a future, or, the belief that one’s future will be very limited.
  • Feel that they belong more to the dead than to the living.
  • The feeling of having a negative “Midas touch”--everything I get involved with goes bad.
  • Loss of self-confidence, and loss of feelings of mastery and competence.
  • A resistance to efforts to change a maladaptive world view that results from the trauma.
  • A mistrust of counselors’ ability to listen.
  • People who suffered traumatic experiences as children, teenagers, or young adults may simultaneously become prematurely aged and developmentally arrested. A part of them “feels old”. Another part feels stuck at the age they had when the trauma occurred.
  • PTSD can be worse if the sufferer experiences the trauma as an individual rather than as a member of a group of people who are suffering the same situation. Unlike earlier wars in which units went overseas together and returned together, in Viet Nam each soldier had an individual DEROS (Date of Expected Return from Overseas). This reduced unit cohesiveness; each soldier experienced the war from an individual point of view. Suicidal people experience their near-death situation with extreme isolation. They see their conditions as being completely unique - “terminal uniqueness”. They have no sense of identification with others.
  • The severity of PTSD symptoms tends to increase with the severity and duration of the trauma.
  • The use of alcohol or drugs to cope with the PTSD symptoms.
  • Attempts to do things to gain a feeling of mastery over the traumatic situation, e.g., become a volunteer on a hot line.

These kinds of conditions may be found again and again in the chronically suicidal. Upon reflection, it should not be surprising that we should suffer PTSD. Many of us suffered from suicidal pain for years - and years - and years. The idea of dying is terrifying. We recoil at thoughts of dying by automobile accident, plane crash, murder, cancer, AIDS, drowning, suffocation. The idea of dying violently simply by forces generated from within ourselves is in some ways almost too horrible to apprehend. How could anyone survive such a prolonged siege of pain and terror - and remain unaffected?

Survivors of traumatic experiences are often told, “It’s in the past. Forget about it and get on with your life,” “Why can’t you just forget about all that, and enjoy life like a normal person?” If we could simply “get on with life”, they would have done it. PTSD helps explain why it is so hard for the chronically suicidal to recover. Because we were suicidal, we subsequently suffered many of the conditions associated with post-traumatic stress disorder. These conditions are serious problems in their own right; they are formidable barriers in the recovery process.

We can heal from the original trauma, and we can heal from the PTSD conditions that have plagued us since the trauma. The basic steps of PTSD recovery programs provide helpful guidelines:

    1. an environment that is physically and emotionally safe
    2. treatment for addictive behaviors
    3. patience: PTSD recovery takes time
    4. caring attachments
    5. restore sense of mastery
    6. rest and relaxation
    7. recall the traumatic event(s) in small steps
    8. gradually assimilate painful feelings and memories
    9. fully experience fear, anger, shame, guilt, depression
    10. grieve one’s losses

In a support group we have a chance to talk about our suicidal histories without the fear that we will be taken to a hospital for doing so. We can talk about the isolation, the fears, the pain, the confusion, the acts of self-injury, the behavior of others that was stigmatizing, denying, abusive, the horrible sense of estrangement that exists when you are in a terrible situation and there is no one who understands what you are going through, the hatred and contempt for oneself and the world, the debilitating sense of personal weakness. We see that we are not alone. We do not have the seriousness of our condition minimized, denied, or belittled. With time, the pain abates and the troublesome PTSD symptoms diminish.

By David L. Conroy, PhD. Reprinted with permission.


The following statistics help to illustrate the magnitude of this problem among Vietnam veterans and their loved ones.

         More than 800,000 Vietnam veterans suffer from PTSD to some extent.

         More than 38 million Americans, nearly 20% of our population, have a direct personal link to a Vietnam veteran, (i.e. parents, spouses, and children).

         The suicide rate for Vietnam veterans is 33% higher than that of the general population. Nearly 180,000 have committed suicide since 1975.

         The divorce rate for Vietnam veterans is double the national average. Among combat veterans, 80-90% have been divorced (some 2 & 3 times).

         Unemployment of veterans is twice the national average.


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