Mental health diagnoses are not undisputedly discovered like a cancer that can be seen with biological testing. To say that diagnoses are socially constructed is not to say they are socially invented or made up. Instead, they are fought for, opposed, and require the right political timing to be acknowledged. As deviance, such as aggression, is seen in large populations diagnoses are sought after in an attempt to explain such behavior. It is not the existence of the disease that is constructed it is the social acceptance and treatment of them that is. Existing symptoms that are organized and thereby labeled as a disorder are constructed to provide a more holistic approach to the care of the disorder. However, this approach may be met with great resistance from interested parties. This is the case for Post-traumatic Stress Disorder (PTSD) as its inclusion, in some form, has been in and out of the Diagnostic and Statistical Manual (DSM) for decades. But how could this be? If a diagnosis is to be believed as scientifically proven how can it be removed and what are the consequences of its removal or inclusion? The individuals that advocate for medical diagnoses are often the people that suffer from the symptoms or care providers that stand to gain financially from the treatment of the disorder (Williams, 2012). The opponents of these disorders are often the insurance companies or, in this case, the government who typically will be responsible for financial reimbursement of the accepted disorder. Although PTSD in not limited to veterans of war, this analysis will be focused on soldiers as they are the most notable figures with the disorder and the ones in which the most scrutiny is allotted.
People exhibiting signs of PTSD have recurring distressful memories of the traumatic event, often in nightmares. They often have a numbing of feelings and emotions and avoid social situations. Many times PTSD sufferers will have a heightened startle response, a short temper, and other distressing symptoms making social situations especially difficult (Affairs, 2007). Emotional problems in soldiers returning from battle have been documented for centuries. In Homer’s Iliad (850 B.C.) the Greek hero Achilles was described as being tormented, in nightmares, by the hundreds of men he had kill in battle (Caffrey, 2009). Similar symptoms have been described as soldier’s heart (Civil War), combat fatigue, shell shock, war neurosis (WWI), and battle fatigue (WWII) (Disorders.com). The DSM is the book that all psychological disorders are diagnosed from in the United States. If the DSM does not include a description for a disorder then for all medical purposes the disorder does not exist and therefore will not be treated or accepted by insurance companies (Scott, 1990).
The first edition of the DSM included a diagnosis for soldiers that were struggling from emotional distress called gross stress reaction. However, it was thought that once the stressor was removed the symptoms would diminish. In 1968, the DSM-II was published and gross stress reaction was removed. This was due largely to decrease in military discharges, from psychological problems, during the Vietnam War (Scott, 1990). Because of great pressure from the Vietnam Veterans Against War (VVAW) groups and psychiatrists treating Vietnam Veterans, Post-Traumatic Stress Disorder (PTSD) was officially included in the third edition of the Diagnostic and Statistical Manual (DSM-III) in 1980. This was the first time that a mental health diagnosis could be given to someone indicating that the disorder was due to something outside the individual (trauma) as opposed to some inherent weakness from within (Wylie, 2011).
In the article What’s A Mental Disorder Even Experts Can’t Agree, Allen Frances editor of the DSM-IV explains that unintentional incentives can be to blame for over diagnoses of disorders like Asperger's in children. He continues to say that the writers of the DSM have to be very careful because if diagnoses can be misused they will be and that could cause a “flood of fad diagnoses” (Spiegel, 2010). This is especially the case with PTSD. Combat veterans receive financial benefits from the government for being diagnosed with the disorder. Reports of the amount of tax dollars being spent on PTSD suffers have an unfortunate side effect in that it can lead the public to believe that the funds are being allocated to people undeserving of the benefits. It is estimated that 20% of the veterans from the Iraq and Afghanistan wars will receive PTSD benefits and that as of 2009 390,000 veterans were receiving benefits (Laird, Unkown)
Reports such as, VA Disability Benefits: Can Anyone Fake PTSD written by Kerry Laird, claim that billions of tax dollars will be allocated to PTSD fraud cases. The article also states that pressure from congress on the Department of Veterans Affairs (VA) make it easier for veterans to file PTSD claims the author states that “The system is dysfunctional, an open invitation to fraud.” (Laird, Unkown) Because of the large amount of money given to veterans due to PTSD claims the military has a stake in seeing that the soldier’s symptoms are due to another diagnosis and not to PTSD. Many soldiers suffering from PTSD symptoms are being discharged or denied benefits with claims of preexisting personality disorders, which cost the military nothing (Kors, 2007)
After reports that 300 cases of PTSD were reversed in an effort to reduce military costs, the head of Madigan Healthcare System at joint base Lewis-McCord in Washington State was placed on administrative leave. This investigation was in response to the shooting of 16 Afghan civilians, allegedly by a soldier from the base. Also stationed at Lewis-McCord was John Allen Muhammad (The “Beltway Sniper”) who was executed in 2009 for killing 10 people.(Press, 2012) Reports such as these have great social effects in that they feed the fear that society has of people labeled with PTSD as being violent or able to “snap” at a moments notice. In the article Despite Deeper Understanding Of Mental Illness, Stigma Lingers Whitney Blair Wyckoff explains that although there is increased knowledge of mental health disorders as neurological, stigmatization of the individuals still occur (Wyckoff, 2010). Despite current efforts by the military to inform the public of their PTSD support, according to President Obama stigmatization still occurs and must be stopped. He expressed his position in the following news conference:
Tuesday, March 20, 2012
Sunday, March 11, 2012
Generation Rx: Film Review
The film Generation Rx is a thought provoking film dedicated to uncovering some of the causes and consequences of American society overly medicating its children. This film states that before the onset of mood altering drugs prescribed to children the pharmaceutical companies saw children as an untapped market. Because of their efforts to market, drugs to children the U.S. saw a 400% increase in mood altering drugs prescribed and according to the film, the U.S consumes 90% of the world’s supply of Ritalin. In fact, 69 billion dollars went to pharmaceutical companies to drug American children. Generation Rx takes an in depth look at how this happened and what some of the consequences have been.
Allen Frances, who is responsible for getting Asbergers into the Diagnostic and Statistical Manual (DSM), described in an article that this is a slippery slope and that although real childhood disorders do occur, over diagnoses and overtreatment will occur which can open the door for many fad diagnoses. (Spiegel, 2010) The film claims that Attention Deficit Hyperactivity Disorder (ADHD) has been diagnosed in epidemic proportions since entrance in the DSM and availability of drugs for children. Psychological disorders rely solely on reports from patients or people around the patients, such as parents and teachers, therefore when one child is diagnosed with something like ADHD parents and teachers begin seeing the same symptoms in other children causing a cluster of diagnosis in certain areas. (Minyard, 2010) This phenomenon is described by Minyard in the article The Autism Information Epidemic.
Generation Rx describes the advertising campaigns that were intentionally developed with children in mind, such as coloring books and cute little rocks taking drugs. All of these things and others lead to the on slot of children on drugs such as Ritalin and Prozac. According to the film, the consequences of this have been astronomical.
The film claimed that the consequences of these drugs have been great. These drugs have caused neurological imbalances in otherwise healthy children. The film points to these drugs as causing violent outbursts in children and suicides. In fact, many of the infamous school shooters were taking some of these mood-altering drugs. Many other physical side effects were also described in the film.
As the film began to look at how this epidemic had happened, they found that there were no scientific consistent tests available for ADHD and that many of the prescribing doctors themselves could not describe the characteristics of ADHD. They found no research that could prove that these drugs significantly increased the quality of life for children. They found that exceptionally gifted children and children young for their grade often exhibited ADHD behaviors. However, what was probably the most disturbing finding reported by the film was that 100% of the panel members responsible for mood disorders in the DSM were financially affiliated with the pharmaceutical companies. In addition, the FDA knew about the increase in suicide due to Prozac and like drugs, but still approved its use in children.
This film clearly points to the multiple conflicts of interest and blatant disregard for the well-being of America’s children for financial gain. It sheds a new light on the perpetuation of the increase in ADHD in children and really questions the validity of using these drugs on children.
To research this further it would be interesting to see the effects of taking these claimed ADHD children and putting them in a different kind of school system, such as one that teaches through hands on experience. I suspect that in a different school format the number of teacher reported cases of ADHD would drastically decrease.
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