Thursday, February 05, 2009


A cry of outrage that the military will not award the Purple Heart medal to soldiers suffering from Post Traumatic Stress Syndrome (PTSD). Thus reports Conn Hallinan on Truthout.

The Pentagon accurately characterizes PTSD as “an anxiety disorder caused by experiencing or witnessing a traumatic event” and “not a wound intentionally caused by the enemy”.

Yet another unfolding of the consequences trailing upon a complicated problem and the not-entirely-above-board efforts to ‘solve’ it.

In the early 1980s PTSD was created as a diagnosis, duly voted into the “Diagnostic and Statistical Manual” (DSM), official bible of psychiatric and psychological practice. It arose in the context of Vietnam Vets, many of whom by then were 10 or even 20 years beyond their service in that unhappy misadventure.

We get into murky waters almost instantly.

Unlike a medical diagnosis (appendicitis, broken bone, gunshot wound), or even certain psychiatric diagnoses that have clear and observable physiological markers accessible to testing, PTSD’s diagnostic indicators were capable of being interpreted as the results of other causes, other issues, not the least of which was ‘faking’ the symptoms, but many of which included less ‘acceptable’ causes such as addictions, the cumulative consequences of bad habits, or poor life choices. Even in the 1980s, you didn’t want to get into the question of ‘characterological’ causes, since to do so would be ‘insensitive’ and would merely be ‘blaming the victim’.

It was a complicated moosh.

So matters remained as the diagnosis was embraced by assorted Advocacies, claiming that the constitutive, signature ‘outrage’ that sustained their ongoing ‘oppression’ was creating a non-military form of PTSD: in other words, the ‘trauma’ was not from an exposure to some chunk of war’s admitted horror that overwhelmed this or that individual soldier, but from experiences more in line with the view of its constituent’s lives put forth by this or that particular Advocacy. ‘Racism’ was said to create a form of PTSD, ‘gender oppression’ created numerous forms, and so forth.

It is a historically established fact that many soldiers have come back from America’s wars ‘not quite right’. After the Civil War, many veterans demonstrated what was called ‘soldier’s heart’; ‘shell shock’ was a World War One term and ‘battle happy’ a (more ominous) World War Two term.

Diagnostically, of course, the competent provider would want to know about symptom onset, including pre-combat or pre-military behavior and performance, to assist in determining the time of onset and perhaps shed much more light on the cause of the symptom. Politically, however, by the early 1980s it became ‘inappropriate’, ‘unprofessional’, and ‘outrageous’ to ask such questions – to inquire into the patient’s ‘past’. This was a bleed-over from various Identity-based legal strategies then (and still) in vogue, and from a particular pop-psychological ‘syndrome’ discovered in 1971 by a Boston College professor called ‘blaming the victim’.

The result was a ‘patient’ self-reporting a number of behavioral symptoms whose causes could quite possibly be other-than-combat, about which no questions could be asked to further refine the cause of the symptoms. Ethically, of course, this was a nightmare since a provider would have to provide ‘treatment’ for symptoms and complaints without necessarily being certain of the cause. But ethics – and professional canons – were rapidly coming to have nothing to do with it.

Now comes Iraq – that misbegotten frakfest – and soldiers are coming back not only with awful physical injuries, but with psychological issues. This is not surprising: the Fourth Generation Warfare and urban and occupation combat situations into which the troops have been dumped and left – for years now – generate intense pressures all their own. It was utterly forseeable.
And once again, it is a matter of determining what the cause might be (including, alas, the possibility that the cause pre-existed the military experience). But again, providers are limited in what they can ask.

And on top of it all, female troops are reporting such symptoms as well, and in high proportions to their numbers. And unless We presume that there is absolutely no truth to the proposition that females are more ‘relational’ and ‘sensitive’ than males, there exists some possibility that female troops in this type of situation are particularly prone to this, in a combat setting that is already psychologically chewing up very large numbers of males.

But, as any military medico will tell you, you can’t even go near that. In this respect We are on the wrong side of the Himmler-Eastern Front problem: since Party dogma defined the Russians as sub-human, then they were presumably not a threat and anything could be done to them. Party dogma was clearly insufficient as a guide to operations , the generals at the front mentioned that to Berlin, but Party dogma, the political element, overruled the actual experience and after a while the generals decided to shut up and keep their jobs. With catastrophic results for the Nazi campaign. When Party dogma starts to control military operations, then things will not end well. And as always, it will be the troops who take the brunt of the frak-up.

Now, on top of the deep-seated complexities and the long-standing mis-handling of the matter, there is a movement to award the Purple Heart to folks demonstrating such symptoms. Nor can it be further asked how the symptoms came to be.

By remarkable coincidence, a recent ‘study’ suddenly reports that “up to” (beware the vagueness) 320,000 troops are suffering from ‘Mild Traumatic Brain Injury’ (MTBI), just recently discovered. Amazingly, its symptoms are “almost indistinguishable from PTSD”.
To the reader who has learned from the dark and long suffering of the Soviet citizenry, there is much here. The “up to” is a telltale warning sign of that statistical sleight-of-hand called ‘extrapolation’: we don’t really know, but if we take a manageable sample, get a percentage, then we can apply that percentage to the whole group and come up with a (usually reeely reeely big) number.

The system has its uses, but it has to be deployed carefully and conscientiously. These are two characteristics not known to revolutionaries as ‘good’ when dealing with ‘emergencies’ and ‘outrage’. The revolutionary or advocacy strategy is simpler: get as many soldiers as you can find hereabouts, make your diagnosis as vague and broad as you can, make sure you get a high percentage of these soldiers here to acknowledge at least one of those vague symptoms, and then apply that percentage (especially if it’s high) to the number of members of the entire military. You get a huge number (320,000, say) and the average reader might assume that you actually have identified without a doubt 320,000 cases. But you haven’t. Not hardly. It’s worked in all sorts of Advocacy situations in the past few decades. It’s being used here now.

Second, why create a second ‘syndrome’, identical to the first and thus equally impossible to fully diagnose – especially given the politically sensitive limitations – when you can’t even handle the first diagnosis adequately?

The answer may well lie in a teensy little bit added by one of the researchers, a female chief of neurology at San Francisco General who has been “working with wounded soldiers at the Army’s Regional Medical Center in Landstuhl, Germany”. She has also, by the by, already written a text-book on MTBI.

In MTBI there is “injured tissue in the brain”. Aha – resolving the old PTSD problem that there were not necessarily any physiological injuries that could be detected by diagnostic equipment and examined. This is a game-changer.

Except – wait for it – MBTI doesn’t show up on CAT scans. Ah. As a Brit might tactfully intone: ‘Oh my’.

But the doc’s got that covered: “This is a complicated injury to the most complicated part of the body”. So we shouldn’t expect evidence or proof. Ovvvvvvvv course.

Except for the behavioral symptoms: ‘depression’, ‘uncontrolled rage’, ‘digestive problems’, ‘emotional disengagement’, ‘blinding headaches’, ‘memory loss’, and ‘sexual dysfunction’ are all mentioned. But surely, and the feminist advocacies especially back this up, such behavior has been demonstrated among males long before ‘Iraq’ – look at the domestic violence stuff, right? And ‘sexual dysfunction’ … has been around for a lot longer than anybody’s military service in Iraq or Afghanistan.

And, while the feminist advocacies will not want to discuss it, such symptoms appear to be fairly rampant among younger females, even in the Hamptons or Malibu.

Another psychiatrist, working with veterans’ families, offers more: “identity ambiguity”, she calls it. “People who were decisive become indecisive. People who were charming become withdrawn.” Sort of like when you were in the old Stages of Mourning back in the ‘70s.

Or, more interestingly, “soldiers who left as a good son, a good father, and a good husband, suddenly start hitting their [sic] children, can’t have sex, start drinking too much, talking too loud”. (She’s going for the mostly male angle, it seems.) This is hardly unknown in returning veterans. And especially to be expected when troops have been forced to not only undergo the sustained pressures of the very frakky warfare in Iraq, but also where troops have had to do things (kick in the doors of family homes, terrify civilians as a matter of operational policy) that no American soldier has ever been sufficiently prepared to do (thank God).

There are many professionals who don’t agree with the existence of MTBI. It is “a slippery beast”, as the article notes. And We have been handed wayyyyy too many slippery beasts – propositions, assertions, ‘facts’, numbers, ‘stories’ and ‘dreams’- for lo these past forty years. Good for them, but how long they’ll be able to hold out is another question altogether. We are in the condition We are in today – as a nation and a society – precisely because too many slippery things have been forcibly replacing the ‘solid’ things. And now it’s all slip-sliding away.

And of course, you don’t get far in modern ‘professions’ unless you can make a splash with your own ‘discovery’. And there’s always surfing to be done on the beach of Sensitivity, where an ‘appropriate’ Kowabunga is always in good form. Let’s give more troops a medal – they deserve something for what they’ve gone through over there. And this is a ‘diagnosis’ that will get them benefits (although where the VA and the government will get such sums nowadays is anybody’s guess).

But I think that there’s also an even darker scheme here. It’s a way to get females a medal that they can all win. And in that regard, I’d be interested to see what the Army’s latest general in striped pants and sensible shoes will have to say about all this – in fact, it’s a curious coincidence that she just took office and suddenly this gambit comes along.

In the military setting, the Purple Heart is an especially freighted medal. It says to everyone who can read the ribbons on your uniform that you’ve been wounded, clear and simple. Soldiers who have been shot or hit with shrapnel or have undergone such bloody assault are recognized by their military fellows for what they went through.

To award it to troops who have ‘no blood’ is not wise from a moral and organizational efficiency point of view. The shedding of ‘blood’ is, as it has always been, of uniquely intense significance – and those who have undergone such an experience (which the military requires all its members to be prepared for) must be recognized. Conversely, those who have not shed blood cannot be so ‘awarded’.

It might be a good thing to borrow the Canadian approach, as the article mentions: create a new medal. The Canadians have created the “Sacrifice Medal” for “those who have suffered mental disorders that are, based on a review by a qualified mental healthcare practitioner, directly attributable to a hostile or perceived hostile action”.

It’s an idea with some merit. If you have to go the route of giving an aware at all. But the Canadians have already had to sail into the trap: “a perceived hostile action” … ? So, if you think you were being shot at, and that alone created a trauma, then you get a medal for that. No, I won’t say it’s so ‘Canadian’, but it is soooo ‘sensitive’. And you can see how quickly the solidities of human motivation and performance, of human nature even, are jellified by the ‘sensitizing’, ‘medicalizing’, feminisitifying tendencies of the past decades. While holding no brief for Pentagoons, I can see why they’re trying to keep Second Wave Party dogma from doing to us something along the lines of what was inflicted on the Wehrmacht by its own version of the Beltway, by ‘Behr-leeen’ as the Nazis used to say in the old war movies. We call Ours ‘the Beltway’.

It also smacks of the last 40 years of education 'reform': nobody flunks and everybody gets a little gold star on their forehead for self-esteem.

Worse, I can see this going the way of the abortion ‘medical certification’. If you can get a doctor to say that carrying the fetus to term is going to upset you greatly, then you qualify for an abortion. Many doctors will, and the Advocacy is now trying to make sure that all of them must.

So much turning to jelly. But that problem, at least, has a clear and identifiable cause. If We can take the appropriate action. But for too many, the disease is better than the cure. Less stressful. Feels better.

This is not a recipe for survival – as adults, as a society, as a culture, as a civilization, as a nation.

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