Wednesday, May 13, 2015

Revisiting the initial question.

Do veterans receive the benefits and care they deserve and were promised? 

This problem is so complex and important to our society; it is not possible for a single discipline to resolve it. It is not as simple as solving PTSD through the VA system with psychology; this problem involves much more than that; there are so many different pieces to the puzzle. Treating PTSD is a very complex process in itself and it does not have a single answer. Additionally, the VA is a multipart system that attempts to treat a wide range of PTSD with treatments that have proven to be most effective. To advance we need to find a way to accurately distinguish the severity of PTSD among veterans. We also need to prescribe treatments that fit the person and not just because it is most effective. That being said, some treatments that are not supported by research need to be

explored further so that they can be utilized or put to rest. For instance, yoga, acupuncture, psychomotor therapy, and medical marijuana. In addition to treatments, outside organizations, foundations, and campaigns are just as important. Having foundations such as The Battle Buddy Foundation can further benefit veterans. This is why assessing this problem with an interdisciplinary approach is key. Treating a veteran with PTSD with cognitive behavioral therapy alone may be effective, but not as effective when combined with a service dog, a yoga routine, monthly acupuncture, and more. Assessing the problem from all angles, and not just one, is essential to delivering veterans the quality care they deserve.

Do service members take advantage of the VA?

It is believed that in some cases service men and women exaggerate or fabricate symptoms of PTSD to receive the benefits. In an article produced by LA Times, it was stated that about half of veterans claiming to have PTSD are exaggerating or lying about their symptoms (Zarembo 2014). Payments to veterans with PTSD are approximately $49 billion (Zarembo 2014). What is concerning is how much of those payments are going to people who are not genuinely suffering from PTSD.

As previously mentioned, the severity in PTSD varies tremendously. Additionally, Zarembo brings up a great point that something that might traumatize one person may not even bother another. These kinds of predicaments make it challenging for physicians to properly and accurately diagnose veterans. A diagnosis for a disorder like PTSD that relies heavily on what the patient reports is a tough call to make. How is someone able to or even allowed to accuse someone of fabricating symptoms for something as serious and as tragic as PTSD? 

Additionally, there are online forums instructing service members what to do when they go in for their evaluation prior to separating from the military. For instance, "Dress poorly and don't shower, refuse to sit with your back to the door, and constantly scan the room (Zarembo 2014)."

This kind of behavior is frustrating for not only physicians, but victims of PTSD. Physicians are challenged with properly diagnosing veterans, however, it can only be assumed that veterans who suffer from PTSD are outraged to hear of people exaggerating symptoms or lying completely to receive benefits. 

A system needs to be developed that aids physicians in being able to better diagnose veterans. Furthermore, we need people to stop taking advantage of the system so that those who truly need it and deserve it can receive their maximum benefits and be taken care of. 

What are some support groups or organizations available to veterans suffering from PTSD?

Beyond treatments, it is essential that veterans are provided with various support groups, organizations, and funds. Fortunately, there are many different support groups, organizations, and foundations solely for veterans and veterans with PTSD.

The Battle Buddy Foundation

The Battle Buddy Foundation accepts donations and partners with other organizations to provide service dogs to qualifying veterans. The goal of this foundation is to allow wounded veterans, physically and/or mentally, to presume a normal life and adapt to the civilian world (TBBF 2015).

Stop Soldier Suicide

Stop Soldier Suicide is another organization established by a veteran. The organization does not claim to be a team of medical professionals but rather a bridge to help service members get help. They are made up of veterans and active duty service men and women. They connect with the service member, they assess and triage, and then they help transition and follow up. The service member can either contact them through their Facebook page, partner organizations, or their 24/7 Resource Center. They then talk with the person and assess their individual needs and the severity of those needs. They will connect them to the proper resource to get them the right help that is best suited for them. Additionally, if they are in crisis and do not want to contact the VA crisis hotline, they will connect them with a VA counselor and stay on the phone with them while they get help. They follow up with people who reached out to them for up to 2 years depending on the severity of the person's needs and the help they received (Stop Soldier Suicide 2014). 


#22KILL is a nonprofit Honor Courage Commitment, Inc. campaign that advocates for the prevention of suicide. They provide people with the VA crisis hotline, as well as Team #22KILL. Team #22KILL is made up of 1,150 active duty men and women, reservists, and veterans who provide their contact information for people in need. Anyone can access their contact information and call them to simply talk, vent, seek guidance, or ask advice. Additionally, they host events, fundraisers, and more. They are commonly recognized for their #22KILL rings that people wear to support those who serve or have served for our country.


Although these may not be considered treatments, they are benefits to service men and women. These are organizations, foundations, and campaigns that support the battles service members face and to help them live a normal and enjoyable life, free of fear. 

What are some alternative or non-traditional treatments for PTSD?

PTSD effects such a large population of people. Among veterans, the severity of PTSD varies significantly. While certain treatments, such as Exposure Therapy, might work for some veterans, it might be necessary for some veterans to go outside the box and explore other treatments that may work better for them. 

Group therapy is a form of treatment where veterans can come together and discuss their experiences with each other. This could be helpful for people who benefit sharing memories with people similar to them and who personally understand what they're going through (VA 2014). 

Psychodynamic psychotherapy helps veterans comprehend how their traumatic experience from the past impact how they feel presently. This helps veterans gain control of their feelings and identifies what memories cause PTSD symptoms (VA 2014). 

Family therapy is beneficial for veterans with families. PTSD can effect a veteran's family tremendously. Not only does the veteran get counseled, but so does the family. This is an opportunity for both the veteran and their family to express their fears, concerns, stressors and more. This type of therapy can be essential in building a solid support group for the veteran at home (VA 2014). 

Defense Centers of Excellence provides a brief statement regarding complimentary and alternative medicine:

"Complementary and alternative medicine (CAM) approaches are often considered alternative to typical medical practices. Acupuncture is often considered a CAM treatment. There is some evidence that acupuncture may improve PTSD symptoms and acupuncture may be considered a treatment for patients with PTSD. Broadly, other forms of CAM include natural products, mind-body medicine, body manipulation and movement techniques, and energy techniques. Overall, there is insufficient evidence to recommend CAM approaches as a first line of treatment for PTSD. Several CAM approaches, such as mindfulness and yoga, are similar to traditional medical relaxation techniques and may be considered as adjunctive treatment of hyperarousal symptoms, although the relative effectiveness of these treatments is unknown. CAM approaches may be considered for patients who refuse other treatments, but providers should consider the risks of CAM approaches and keep in mind that treatments that have a limited evidence base for effectiveness also have a limited evidence base for potential harm and side effects (DCOE 2015)."

Additionally, an article in the New York Times discusses psychomotor therapy as a successful treatment for PTSD. Bessel van der Kolk, a Dutch psychiatrist, practiced psychomotor therapy on an Iraq War veteran. Pyschomotor therapy was developed by a dancer named Albert Pesso. This therapy involved PTSD victims reenacting their experiences with other people. While the veteran plays out what happened, people serve as characters in his story and recreate his experience. During the traumatic portion of the experience, the characters feed the veteran words of encouragement and forgiveness. Recreating the experience allows the veteran to associate those positive feelings with their memory rather than their negative associations which lead to symptoms of PTSD. The article stated that this kind of therapy is not commonly practiced or supported, however, this psychiatrist believes it can really benefit some people (Interlandi 2014). 

Click here to read the article. 

In contrast, in a WQAD article the topic of medical marijuana is discussed. Recently at an Illinois Medical Cannibis Advisory Board meeting, it was suggested that PTSD be added as a condition that elicits the use of medical marijuana (Simmons 2015). Click here to watch the news coverage.

Many of these treatments are not clinically supported. Perhaps some of the funding being put toward VA psychiatric resources and suicide prevention, should also go towards researching these various treatments. As stated previously, it is likely that Exposure Therapy does not work for every veteran with PTSD but maybe acupuncture would. It is important that we explore all options due to the wide range of severity in PTSD. 

What are the VA's treatments for veterans with PTSD?

Cognitive behavioral therapy is the main treatment for PTSD. Cognitive behavioral therapy includes Cognitive Processing Therapy and Prolonged Exposure Therapy. These forms of therapy have proven to have positive effects on veterans witPTSD.

Cognitive Processing Therapy aims to change how a patient perceives the trauma they experienced. It also aims to help the patient comprehend how they may bring stress onto themselves and, as a result, make their condition worse. Veterans should be able to effectively deal with feelings of anger, guilt, and being afraid following cognitive therapy (VA 2014). 

It is common that we associate bad memories with being afraid, being fearful, and angry. However,  Prolonged Exposure Therapy aims to desensitize veterans of their bad memories. By talking about those memories and what types of feelings they evoke, veterans are able to gain better control of their feelings, thoughts, and actions (VA 2014). 

Eye Movement Desensitization and Reprocessing is being implemented for treatment of PTSD, as well. This involves the patient tracking the movement of the therapist's hand or foot with their eyes. The therapist may tap their hand or foot, while the patient recalls their traumatic memories. This allows the patient to openly talk about what they went through or witnessed while focusing on something else (VA 2014). 

In addition, pharmacology is commonly used in treating PTSD. Different medications have proven to be effective in helping people cope with their PTSD and various symptoms that they experience. For example, selective serotonin reuptake inhibitors, which are classified as an antidepressant, are commonly prescribed (VA 2014). 

Why is the VA system a debated topic?

The main question is: Do veterans receive the benefits and care they deserve and were promised? 

A very common disorder among service members is Post Traumatic Stress Disorder. Post Traumatic Stress Disorder can be caused by witnessing or experiencing something traumatic. Traumatic experiences include "combat, a terrorist attack, sexual or physical assault, a serious accident, a natural disaster or childhood sexual or physical abuse (DCOE 2014)." 

As of March 2014, there were just shy of 35,000 cases of PTSD among service members who had not deployed. Among service members who had deployed, there were a little over 121,000 cases. These numbers only reflect the reported cases of PTSD (DCOE 2014). With such a high rate of veterans with PTSD, it is a concern that the VA system does not provide enough care. 

There is reason to believe this because Veterans Affairs stated in 2013 that 22 veterans commit suicide every day; PTSD can lead to suicidal thoughts. That being said, that number is based off of reported suicides. Not all deaths are reported as a suicide, even though in many instances among veterans, it is the case. 

Fortunately, because this is such a significant issue, more funding is being provided for suicide prevention (Parnell 2015). Additionally, a law was passed this year with the intention of improving the VA's psychiatric services and suicide prevention (Parnell 2015). 

So what's the problem? Why is this such a "hot" topic? Why are people doubting the VA? 

People are doubting the VA because the process in which a veteran has to go through to access these resources is not quick enough for someone who is contemplating suicide (Parnell 2015). 

Below is a video released on ABC News regarding an Iraq War veteran's suicide. 

Monday, May 11, 2015

A General Overview of the Department of Veterans Affairs
The Veterans Affairs system was founded in 1930. It is a government, military-run organization that provides various benefits to service members, and in some cases, their spouses and children. One of the main functions of the VA system is to provide healthcare benefits to veterans who qualify. When a service member receives a final physical prior to separating from the military, the soon-to-be veterans claim symptoms and signs that lead to a diagnoses of a disability. The amount of money and/or benefits the veteran will receive, depends on the severity of the disability. Any given disability can be broken down into percentages. For example, a severe disability may elicit 100% compensation, while other minor disabilities may elicit a lower percentage.