Sally Satel, shrink and author, has an excellent piece in today’s New York Times on the skyrocketing claims by veterans that they suffer from post-traumatic stress, a disorder that’s tricky to evaluate. 

The Department of Veterans Affairs is now paying $4.3 billion a year for such claims, with nearly twice as many veterans saying they suffer from this disorder as six years ago. Even more striking, most are not veterans of Iraq conflicts but of the Vietnam war.

Satel writes:

“This leads to an obvious question: Can it really take up to 40 years after a trauma before someone realizes he can no longer cope with the demands of civilian life? The answer: possibly, but it is often hard to know which applicants can be helped with short-term psychiatric care, which are seeking a free ride and which are truly deserving of the diagnosis of post-traumatic stress disorder and thus long-term care and payments of up to $2,300 a month for life. The task before the Veterans Affairs Department is to come up with criteria.

“Medically speaking, there is some evidence to support what psychiatrists call ‘reactivated’ post-traumatic stress disorder. The literature is dotted with cases of veterans of World War I, World War II and the Korean War who, after briefly showing signs of stress disorders in the immediate aftermath of their ordeals, led productive lives for decades before breaking down in their 60’s and 70’s. Little is known about the treatment of reactivated symptoms, but there is reason to be optimistic that patients will recover nicely in view of their having functioned well for so long.”

While Satel, who has worked as a psychiatrist in a Veterans hospital, takes the complaint of PTS seriously, she sees the disturbing possibility of something else at work in the rising claims:

“But it’s also very likely that some of the veteran baby boomers who have filed claims in recent years did so not out of medical need but out of a desire for financial security in their retirement years. Indeed, 40 percent of last year’s claimants had been out of the military for 35 to 49 years.

“In any case, the rush of applications for long-term disability entitlements reflects the extent to which the culture of the Department of Veterans Affairs since Vietnam has become fixated on post-traumatic stress disorder. While claims for all other forms of mental illness, like schizophrenia and bipolar illness, have declined by about 12 percent of patients at veterans’ hospitals over the last decade, the number of veterans receiving compensation for post-traumatic shock has nearly tripled.”

It is interesting that on the day Satel’s op-ed appears, the Washington Post has a piece on the increasing numbers of Iraqi war soldiers who seek help for mental distress:

“The accounts of more than 300,000 soldiers and Marines returning from several theaters paint an unusually detailed picture of the psychological impact of the various conflicts. Those returning from Iraq consistently reported more psychic distress than those returning from Afghanistan and other conflicts, such as those in Bosnia or Kosovo.”

The profession of arms is an honorable one-but down deep, most of American society no longer believes this. Could this be an added reason for soldiers’ needing psychiatric help? This is not to downplay the very real ordeal of war, but you’ll note that the Iraq war, shunned by the nation’s elite media, has generated “more psychic stress” than Kosovo.