Saturday, July 17, 2010

"Common Sense" from the WSJ and the AEI

Today's Wall Street Journal features an article on the history of post traumatic stress syndrome (PTSD) by Sally Satel, a resident scholar at the American Enterprise Institute, a right wing think tank.  While Satel concedes that PTSD is a legitimate psychiatric diagnosis, she carefully crafts the impression that there is something fishy going on and that liberals are to blame.

Veterans with unrelenting PTSD can receive disability benefits from the Department of Veterans Affairs. As retired Army Gen. Eric K. Shinseki, secretary of Veterans Affairs, said last week, the mental injuries of war "can be as debilitating as any physical battlefield trauma." The occasion for his remark was a new VA rule allowing veterans to receive disability benefits for PTSD if, as non-combatants, they had good reason to fear hostile activity, such as firefights or explosions. In other words, veterans can now file a benefits claim for being traumatized by events they did not actually experience.

The very notion that one can sustain an enduring mental disorder based on anxious anticipation of a traumatic event that never materializes is a radical departure from the clinical—and common-sense—understanding that disabling stress disorders are caused by traumatic events that actually do happen to people. This is not the first time that controversy has swirled around the diagnosis of PTSD.
My common sense would tell me that multiple extended rotations in a high risk environment where every pile of rubble potentially hides an improvised explosive device has the potential to cause harmful levels of stress.  However, I would question whether it even makes any sense for a psychiatrist to talk about about "common-sense" understandings of "disabling stress disorders."  Would Satel appeal to "common- sense understandings" of autism or schizophrenia or bipolar disorder?  Sometimes unusual problems defy common sense.

Interestingly, the article seems to concede that common sense got things wrong for a long time.  According to Satel, during World War I, the common-sense understanding was that soldiers suffering from "shell shock" had some personal mental shortcoming.  "Otherwise well-adjusted individuals were believed to be at small risk of suffering more than a transient stress reaction once they were removed from the front."  As time went by, however, psychiatrists came to the conclusion that that every soldier had a breaking point.

By the end of the article, Satel article even seems to concede that the common sense to which she appeals may be wrong:  "For some non-combat servicemen and women, anticipatory fear of being in harm's way can turn into a crippling stress reaction."   If this is so, why does she characterize this as a "radical departure"?   As is usual when you find the Wall Street Journal and the American Enterprise Institute appealing to common sense, there is some eggheaded liberals to be bashed. In this case it is the opponents of the Vietnam War who pushed the legitimacy of PTSD as a psychiatric diagonsis.  Satel doesn't dispute that legitimacy.  She just wants us all to know that there is a political agenda at work.

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