Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Monday, January 02, 2006

    Benefits of Illness: Post-traumatic stress disorder has been gaining momentum in the media lately. Doonesbury has been highlighting it for some time in the cartoon character of B.D., who lost his job and a leg in Iraq. And the December issue of the American Journal of Psychiatry is largely devoted to the issue. Last week, Dr. Helen noted the impending politicization of post-traumatic stress disorder heralded by this article from the Washignton Post. Most of the article focuses on the question of paying out disability benefits for the disorder. No one questions the disorder exists, but like other illnesses that are entirely dependent on subjective information and come with their own special financial compensation (such as work-related or accident-related chronic back pain, whiplash, and repetitive motion injuries), it is easily exaggerated - and sometimes out and out faked. What's more, since it's a purely psychological disorder, recovery from post-traumatic stress disorder is determined more by the psychology of the patient and his environment than by the extent of the trauma. As Dr. Helen points out, if a sufferer of PTSD is told he'll never recover, then he won't. If he resents the circumstances that put him in the way of trauma, if he's encouraged to assume the role of passive victim, whether by a therapist or by family and friends or by the conventional wisdom of society at large, then the recovery will be harder. Which is why the prospect of politicization is especially disheartening. And why this statement by a VA official in The Washington Post is especially concerning:

    The growing national debate over the Iraq war has changed the nature of the discussion over PTSD, some participants said. 'It has become a pro-war-versus-antiwar issue,' said one VA official who spoke on the condition of anonymity because politics is not supposed to enter the debate. 'If we show that PTSD is prevalent and severe, that becomes one more little reason we should stop waging war. If, on the other hand, PTSD rates are low . . . that is convenient for the Bush administration.'

    What side of the issue do you suppose he's on? And which side of the war debate stands to profit more by politicizing post-traumatic stress? No surprise, then, that there were not one, but two stories about PTSD in today's local paper - each with a local angle. One is the story of a reluctant soldier who says that no one is helping him, and the other is an interview with a psychologist who specializes in its treatment, and who believes it is the major morbidity of the war in Iraq, and that we'll be seeing an upsurge of cases locally as men and women return from the war. (They've been going and returning from the war for a couple of years now, so you would think there would be some concrete data instead of speculation, but never mind.)

    Expect the media to continue to pound this meme. And as they do, remember that post-traumatic stress disorder is not unique to soldiers. Policemen and firemen suffer from it, too. Yet no one expects us to stop policing our streets or fighting fires to avoid psychological suffering in our police and fire departments. And most of all, let's not forget that those who live under a reign of terror can also suffer from post-traumatic stress disorder. I suspect that most of our soldiers recognize this. If only our politicians, and politicized VA officials, recognized it, too.

    UPDATE: From a reader:

    It is unfortunate that there is no commonly recognized way to rank the severity of PTSD. It leads to misunderstandings.

    The experience from World War I, World War II, and Vietnam was that 2-5 percent per year of combat troops would require hospitalization for PTSD. This is not the few months rest and therapeutic conversations that was needed by nearly 100 percent of combat veterans, and that suffices for the more common PTSD of civilian life. You do not find 2-5 percent per year of police or firefighters needing hospitalization to deal with psychotic breakdowns due to PTSD.

    It is also unfortunate that the politicians seem to be making this into a pro-war or anti-war thing rather than a support the troops issue. It was upsetting to see that at the same time we went into war the administration decided to cut VA medical funding. A more competent administration might realize that war means wounded soldiers, and wounded soldiers need medical treatment. When you go to war you need to increase VA medical funding because the seriously wounded veterans will be needing VA services for many years after their return.

    posted by Sydney on 1/02/2006 05:28:00 PM 0 comments


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006