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PTSD and the Vet

Psychiatrist Sally Satel has a thoughtful article on the change in diagnosis of PTSD by the Veteran's Administration.  As Dr. Satel mentions:

On July 12, 2010, General Shinseki penned an op-ed in USA Today ("For Vets with PTSD, End of an Unfair Process") announcing a new Veterans Administration rule making it easier for veterans suffering from PTSD to file disability claims. Part of the rule was straightforward: The VA would no longer require that a veteran provide documentation of his exposure to combat trauma, seeing how such paperwork is often very difficult for veterans to obtain. Streamlining the lumbering claims bureaucracy is one thing, and welcome it is, but the new rule does not end there. It also establishes that noninfantry personnel can qualify for PTSD disability if they had good reason to fear danger, such as firefights or explosions, even if they did not actually experience it. "[If] a stressor claimed by a veteran is related to the veteran's fear of hostile military or terrorist activity, he is eligible for a PTSD benefits," according to the Federal Register. This is a strikingly novel amendment. The idea that one can sustain an enduring and disabling mental disorder based on anxious anticipation of a traumatic event that never materialized is a radical departure from the clinical--and common-sense--understanding that traumatic stress disorders are caused by events that actually do happen to people. However, this is by no means the first time that controversy and ambiguity have swirled around the diagnosis of PTSD (emphasis added).

My Sixth Sense tells me that we'll see this in the civilian context in the near future. 


This is one more instance of the phenomenon of diagnosis creep.

As soon as some tangible benefit attaches to a diagnosis, pressure begins to expand the criteria to cover more people. The benefit could be SSI disability benefits, veterans benefits, or insurance coverage for otherwise uncovered psychotherapy. In the criminal law context, it could be a reduced sentence or even exemption from criminal punishment altogether.

This is an excellent and balanced article.

To conclude total disability from PTSD before a course of therapy and rehabilitation is tried is irresponsible to the taxpayers and self-defeating for the veteran.

This change to include "anticipatory" trauma will exacerbate the problem.

You mention that fact it may appear in the civilian context, and I assume that means criminal sentencing. If PTSD could be documented medically, would you oppose its diagnosis in mitigating sentences?

Under existing Supreme Court precedent, the sentencing judge or jury may consider just about anything. My own view is that mitigating factors should be construed narrowly but the providence of the jury in according them weight should be rather unrestrained.

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