Yesterday we learned that mental health professionals in Veterans Adminstration offices were being told what diagnosis they could give to Veterans being assessed for psychiatric sequelae related to the war. Given the recent cover-up of incidence of suicide, this is further evidence of the dishonest, callous, unethical, and inhumane behavior of this administration.
Keith Olberman discussed this tonight on Countdown.
As a licensed clinical social worker in the State of Massachusetts, a former board member of the Massachusetts National Association of Social Workers, and an adjunct faculty member teaching at now two graduate schools of Social Work, I want to inform everyone, especially Vets, that while the Veteran’s Administration can attempt to dictate diagnosis, which is highly unethical, Social Workers are ethically bound to give the diagnosis that best fits the reported symptoms. The VA is evidently ordering professionally trained persons to violate their ethical responsibilities, and to give diagnosiis that do not fit the presenting symptoms, or fail to fully explore clinically significant symptoms
Vets can arm themselves in their battle for rightful benefits with knowledge:
MAKE SURE YOU ASK WHAT DIAGNOSIS IS BEING GIVEN AT THE TIME OF THE ASSESSMENT, AND KNOW WHAT IT MEANS. INSIST THAT THE SOCIAL WORKER DOCUMENT YOUR SYMPTOMS ACCURATELY AND FULLY. ALSO BE SPECIFIC IN DESCRIBING SYMPTOMS. IF YOU FEEL THAT THE SOCIAL WORKER IS NOT ACCURATELY REPORTING YOUR WORDS, ASK FOR A SUPERVISOR. A social worker who is making this diagnosis should have completed a master’s degree and thousands of hours of supervision in working with clients. They must then take a licensing exam, and cooperate with continuing education after receiving an INDEPENDENT CLINICAL LICENSE. If you are being seen by an LCSW or other non-clinical degree, ask who their supervisor is, and get their name. Insist that you are able to see a fully licensed person, and be sure to get their contact information, name and degree in full.
Information is the best antidote to exploitation so here goes: Here are the DSMIV (Diagnostic and Statistical Manual) diagnostic criteria for Adjustment Disorder, and for Post Traumatic Stress Disorder: These diagnosis are worlds apart in terms of Veteran’s benefits and/or insurance coverage. Adjustment Disorder is the mildest possible diagnosis that may be given in order to qualify for minimal benefits. Post Traumatic Stress Disorder is far more complicated and requires significant treatment over a longer period of time. It will often require several bout of treatment over a lifetime and can be chronic and highly diabling.
These are the criteria listed in Diagnostic and Statistical Manual of Mental Disorders, fourth addition; Virginia; American Psychiatric Association,
Adjustment Disorder : DSM Code 309. (followed by various qualifiers, including depressed mood, anxiety, mixed anxiety and depressed mood, disturbance of conduct, with mixed disturbance of emotions and conduct, unspecified)
Diagnostic Criteria for Adjustment Disorders
The development of emotional or behavioral symptoms in response to identifiable stressors occurring within 3 months of the onset of the stressor (s).
Thse symptoms or behaviors are clinically significant as evidenced y either of the following;
marked distress that is in excess of what would be expected from exposure to stressor.
Significant impairment in social or occupational (academic functioning)
The stress-related disturbance does not meet the criteria for another specific Axis 1 disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
The symptoms do not represent Bereavement.
Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Specify if:
Acute: if the disturbance lasts less than 6 months
Chronic; if the disturbance lasts for 6 months or longer.
Adjustment disorder is characteristically described as an overly strong adverse response to a fairly routine or normal life event.
Diagnostic Criteria for Posttraumatic Stress Disorder 309.81 (with specifiers if acute/chronic, or with delayed Onset.)
The person has been exposed to a traumatic event in which both of the following were present;
1.the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
2.the person’s response involved intense fear, helplessness, or horror.
The traumatic event is persistently reexperienced in one (or more) of the following ways:
- recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
- Recurrent distressing dreams of the event.
- Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).
- Intense psychological distress at exposureto internal or external cues that symbolize or resemble an aspect of the traumatic event.
- Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by three of the following:
1.efforts to avoid thoughts, feelings or conversations associated with the trauma.
2.Efforts to avoid activities, places, or people that arouse recollections of the trauma
3.Inability to recall an important aspect of the trauma
4.Markedly diminished interest or participation in significant activities.
5.Feelings of detachment or estrangement from others.
6.Restricted range of affect (e.g. unable to have loving feelings)
7.Sense of a foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span.
Perisistent symptoms of increased arousal (not present before the trauma) as incidated by two or more of the following:
1.difficulty falling and staying asleep
2.irritability or outbursts of anger
3.difficulty concentrating
4.hypervigilance
5.exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B,C, and D) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other areas of functioning.
Notice that the primary qualifiers for assessing Adjustment Disorder require only normal or expectable life events, where the emotional response may be determined to be "outside the norm" or excessive.
The primary qualifier for PTSD is actual exposure to violence to self or other, witnessing violence, or actual death or dismemberment of persons.
The VA should be routinely assessing every soldier for PTSD, since these are human beings who are being asked to involve themselves in inhumane, violent and psychologically dangerous circumstances. These are known high risk factors, which establish a high likelihood for widespread experience of Post Traumatic Stress Disorder. It is has been widely under-diagnosed and under-treated among Vietnam Veterans, and the fact that a directive of this type is being made to professionally trained mental health personnel during a war, is appalling. The state is asking mental health professionals to violate their ethical standards or lose their jobs. The VA should fully expect a high likelihood of widespread PTSD and expect that widespread treatment will be required. The VA should not be "screening out" veterans. It should be screening them in, to avoid long-term suffering and secondary consequences to vets and their loved ones.
Some might argue that human beings are not meant to witness or be forced to participate in violence, and that the price of this is PTSD as a nearly inevitable occurrence in an otherwise healthy psyche.
Part of pursuing a war is to anticipate the actual costs in terms of human life, human suffering, as well as the required care following a war. By now it is clear that our elected officials have cheated on every measure of the cost of the war to soldiers and citizens, while enriching corporations with carte blanche contracts.
When these saber-rattling cretins hold forth in the Knesset, or on the stump, I am mindful of all the hypocricy we have seen these last years, and the underreporting of suicide statistics, and attempts to fudge professional diagnosis and treatment to save money are further evidence that this administration and its spawn should not be anywhere near public office.