Jerry Lembcke - PTSD and mTBI as social constructs

[ajb1812]

Has anyone read Jerry Lembcke's book, PTSD: Diagnosis and Identity in Post-Empire America?

He's a sociologist and Vietnam War Veteran who has written about the "mythology" associated with Vietnam and is now discussing how society uses PTSD and, more recently, mild TBI as a way of both pathologizing our Veterans and providing them with "wounded warrior" credentials.

I don't agree with everything he's written, but it's an interesting take and does ring true in the sense that we've created a culture where Veterans hold up their "I'm 100% PTSD" rating as an identity. Would love to hear others' take on this.

There's an interview with him on Salon.com as well:
http://www.salon.com/2014/05/26/our_american_mythology_what_were_all_getting_wrong_about_veterans/

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[erg923]

I think there is a mentality that trauma = PTSD. Which, of course, is not true at all.

I also think there has been so much of focus on it within the VA system that those that have some symptoms associated with trauma get "diagnosed" or told how bad they need treatment. Many of these Vietnam vets have been functional for years and then the reason given is that when they retire, they dont have the distraction and then they become more symptomatic. Largely, I think this is bull****. I think there are many subtle levels of adverse trauma reaction though...its just not PTSD.

And yes, vets who don all the regalia from head to toe kinda baffle me. Its like getting raped in a red dress then walking around in the red dress the rest of your life. The "disabled vet" line of acessories is the worst though

 

[PsyDr]

It's like there is a large amount of tax free incentives to report symptoms.

Thank god, there are no socioeconomic reasons that the federal government would want to transition unskilled unemployed individuals with no retirements saving from "unemployed" to "disabled". Oh wait...

 

[sockit]

well, why might these individuals be unemployed and unskilled to begin with? what are their other real options? why would someone join the army in the absence of conscription? a lot of people, i am given to understand, sign up because it's one of few ways out of an even tougher situation. for an education, a career; a sense of purpose or community; or maybe they were massaged into it. if a country is willing to use people it failed to support in other ways, i'm tempted to say, fair game.

maybe the mythologizing of vets is one way of not addressing structural disadvantage.

(duh, sorry - sarcasmeter's on the fritz today :/)

 

[ajb1812]

I think there is a mentality that trauma = PTSD. Which, of course, is not true at all.

I also think there has been so much of focus on it within the VA system that those that have some symptoms associated with trauma get "diagnosed" or told how bad they need treatment. Many of these Vietnam vets have been functional for years and then the reason given is that when they retire, they dont have the distraction and then they become more symptomatic. Largely, I think this is bullcrap. I think there are many subtle levels of adverse trauma reaction though...its just not PTSD.

And yes, vets who don all the regalia from head to toe kinda baffle me. Its like getting raped in a red dress then walking around in the red dress the rest of your life. The "disabled vet" line of acessories is the worst though

Exactly. And the comp and pen system makes it so hard to avoid reinforcing disability when you can essentially claim any exposure to combat situations as a criterion A event. It's a lot easier to attribute one's failure to thrive to the 2-3 rocket attacks they witnessed in Afghanistan than to lack of education, economic/social disadvantage, or just plain bad luck.

 

[WisNeuro]

These days mTBI is the problem, largely due to the terrible literature out there on CTE. That's what I see more of.

 

[AcronymAllergy]

These days mTBI is the problem, largely due to the terrible literature out there on CTE. That's what I see more of.

Yep; made particularly bad because it's a historical diagnosis based solely on self-report, and with pretty much zero current evidence of any persisting injury-related physiological after-effects. I mean, unless you count DTI...

 

[WisNeuro]

The dti stuff is interesting.

DTI has the potential to be interesting. Right now it is suffering from the same shortfalls that fMRI did in the beginning. People are using it, with bad methodology and analysis, to show what they want it to show, rather than using good design and solid analysis to explore hypotheses.

 

[edieb]

I worked at the V.A. for two years after receiving my Ph.D. My colleagues and I had never experienced such a welfare and entitlement state in our entire lives. Living on the U.S.-Mexican border, it always amazed me how people who emigrate from Mexico and had witnessed their entire families massacred by the drug cartel can come to the USA and become productive citizens but the Veterans, with all the supports they receive, cannot even get a job

 

[edieb]

Edieb. That is severely unfair. One, not every Mexican that comes over here works hard and is a productive citizen. Believe it or not, some of them are poor, have more children than they can support and commit crimes. Likewise, veterans are a diverse bunch. Many of them are very successful, some of them are not and some of them are legitimately injured and legitimately mentally ill.

I think at the Ph.D.-level we can assume that I know not +every+ immigrant is an angel nor is + every+ Veteran terrible. Rather, I am aligning with Lembcke's assertion. From my experience, and the experience of 7-8 other psychiatrists, psychologists (two who are heads of Compensation and Pension Departments) and social workers, the perception is shared. Again, I am not referring to people whose legs have been blown off or have sustained catastrophic TBI. We owe it to help those people

There are evidence-based treatments for PTSD (CPT and PE) and, for those who want to improve and be productive, there is no excuse to be collecting your welfare (service connection) check for 30 years. It is inexcusable. Maybe instead of staying home and playing victim, you can do work from one of the workbooks for PTSD.

However, from everybody's experience, 90 percent of the Veterans seeking treatment would come in without their homework done or half very partially completed homework. When I would tell them I was a Veteran who had seen combat, I would be dismissed. I hate to say it but a lot of these people just don't want to get better.

I think we often mis-use the word "valor" in our society. To me, valor is the willingness to walk across a desert in 110 degree weather for hopes of finding a $8/hour job to help your family, not collecting payments for life for a disorder that is, at the very least, amenable to treatment. I would love to see the stats on how many of these people stop voluntarily collecting benefits for PTSD. I imagine it is zero.

 

[AcronymAllergy]

Agreed. Being susceptible to the effects of secondary gain, particularly when it's structured in some of the ways that SC and other related benefits are, isn't something that's somehow unique to veterans. Beyond that, of course remember that in the VA, you're only seeing a subset of all veterans (with mental health only seeing a small subset of that subset).