Nick Kristof wrote a fine, wrenching story in the New York Times last week describing the suicide of a veteran with PTSD. The numbers are telling:
"For every soldier killed on the battlefield this year, about 25 veterans are dying by their own hands. An American soldier dies every day and a half, on average, in Iraq or Afghanistan. Veterans kill themselves at a rate of one every 80 minutes. More than 6,500 veteran suicides are logged every year — more than the total number of soldiers killed in Afghanistan and Iraq combined since those wars began."
Reading and reflecting upon Kristof's story brought this response from one psychiatrist familiar with the difficulties of treating PTSD:
To the Editor:
As a psychiatrist working in the California Department of Corrections, I see many cases of post-traumatic stress disorder. Reading Nicholas D. Kristof’s column, I wondered whether the American public has a clear notion of the challenge that this condition presents to the clinician.
PTSD is one of the more difficult psychiatric diagnoses to treat. No particular medication is highly effective, and therapy is almost always long and arduous.
It’s painful to have to acknowledge this, particularly if one suffers from PTSD or is related to someone who does, but rarely does it pay to ignore reality. Perhaps this fact should figure in the balance when we are deciding to send our kids off to war.
ROBERT B. LEVIN
Capitola, Calif., April 15, 2012
We still have a tendency to believe that physical and psychological illnesses are separate categories. That distinction, like the underlying separation of body and mind, is often convenient but essentially false. Post Traumatic Stress Disorder (PTSD) is indicative of changes in the neural circuitry of the brain that controls emotions. As another neuroscientist has recently written, "Disorders of neural circuit function, even if one cannot see them under a microscope or in a brain scan, are every bit as 'physical' as the consequences of major head trauma. The false distinction between 'psychological' and 'physical' bases of mental illness encourages the public’s [and sometimes the patient's] inclination to 'blame the victim' and the insurance industry’s resistance to providing adequate coverage for treatment."