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PTSD:To Be Or Not To Be? Part II

Oct 20

G’day all!  Before we get to the “unspoken stuff” related to “PTSD”, I apologize for my long absence.  Once again I was on the road consulting with foreign customers.  I remain “gobsmacked” at the similarities between police people, no matter where they are in the world.  As has become our custom, I offer a tip of your Stetson to those who are reading this blog from afar.

May I suggest that if you haven’t read Part I of this topic, you do so before digging in to Part II.  In general with regard to Part I, I went beyond questioning the “diagnosis”, to poking enough holes in it (without demeaning your suffering) to sink it!  And I used the investigative skills that you taught me!!  A proviso:  When I outline the results of this investigation, I am not attempting to discredit in anyway what your emotional experience related to any single event (or series of events) may be.  I am not attempting to be your therapist.  I am not attempting to discredit your therapist, if you have one, or his/her theoretical orientation.  I JUST WANT YOU TO THINK FOR YOURSELF!!!!

Now to the “unspoken stuff”.  It seems that a relationship between subjective symptom experience and financial benefit can play a role in the “diagnosis” of PTSD. When researchers review the medical records of patients they discover a consistency and uniformity in subjective reports.  This of course could reflect the development over time of a more precise set of diagnostic criteria and/or the reliability of diagnosticians; it could also reflect the expectancies and unfounded elicitations of the examiners.  This is not the first time that this cultural bias has been noted; it can be found in the reports of patients suffering “shellshock” and “contusion” (English and Russian precursors to “PTSD”, respectively) during WW I.    The interesting thing is that these early diagnoses had  different symptom pictures that would qualify them as traumatic responses, but were characterized by the same uniformity we see today.  Historically victims were prone to shaking, stuttering, limping, deafness, muteness, and blindness.  They did not report the intrusive, avoidant, re-experiencing, anger, or numbing symptom picture that we see today in trauma patients.  Moreover, there does exist today examples of applicants for financial compensation being coached as to how to present themselves to examining physicians who will be central in the determination of their disability benefits.

In closing, it is commonly noted in military settings that the report of the patient is incongruent with military records.  One seminal study found that 32% of the patients assessed had no evidence in their military record to support the details (e.g. battle experience) they reported.  Several studies have reported that those who aggressively pursued compensation were more likely to over report and exaggerate their symptoms.  A 2005 report from the US Veteran’s Administration Office of the Inspector General noted that veterans’ symptoms increased in severity until their compensation reached 100% disability; followed by a decrease of 82% usage of mental health services and NO change in the use of other medical services.

So in summary, it can be strongly suggested:

I) Current diagnostic criteria for “PTSD” are unsatisfactory.

ii) It isn’t easy to distinguish between what may be an actual disease entity (PTSD) and A NORMAL HUMAN RESPONSE to trauma.

iii) It is difficult to sort out anxiety, depression, and substance abuse disorders.

iv) The diagnosis of “PTSD” today relies on largely unverified and subjective reports of trauma, and symptoms.

v) Financial compensation, could be (even out of the patient’s awareness) an important factor leading to secondary gain.

Well there you have it.  Let’s hear from you?  Personally, I find this very liberating!  I remain the “Captain of my own ship” and continue to have the ability to plot my own course.  And please never, ever forget………”There is no fear!  We are in error when we view life’s challenges as unjust impositions rather than the simple facts of life; or just another opportunity to grow”.

Dr. Mike Webster

Reg’d Psych   (#0655)

P.S.   I’m on the road again.  Keep those cards and letters coming in.  I’ll get to them in about a week when I return.  In the meantime “riddle me this”………..if you don’t who does, if you can’t who can, if you won’t who will?  There you go……..so just ‘DO IT”!!!!!!!

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5 Comments
  1. Anon permalink

    I think this is an interesting point. I was diagnosed with ptsd as a result of being compelled to see Health Canada during a prolonged harassment incident. I didn’t want to go, I didn’t want the dx, I wanted to go to work and get over it. I felt pressured and manipulated by an organization that had labeled me inconvenient and confrontational and had to find somewhere to put me even if it meant disabling me literally or figuratively. I fought back to return to work. Didn’t want to be off. Made it back to work. Faced discrimination and harassment as soon as I returned just the usual RCMP culture. It’s still going on 2 years later. Just recently my health records were pulled by my boss. Never asked, meddling in my health which had been pretty stable until then. It brought back all the badness relating to what had happened before and I feel unwell as a result. But I still don’t know that I have ptsd. I feel it is a stress reaction that my employer keeps provoking with their aggressive and clumsy, sometimes illegal manhandling. My husband who has experienced 25 years of combat stress also doesn’t think he has ptsd. We are like two people who fall through the cracks. We both suffer from anxiety and can be loopy sometimes and incredibly focused and sane and bottom line stable at the same time, we keep going. I often think of my grandfather who was in WW1 and survived unimaginable hardship. He survived without ptsd. Lost all of his friends who fell beside him. Maybe it’s genetic. Maybe it’s genetic also for my husband who refuses to let his experiences define him. In my own case I feel the term ptsd has been misused. Adjustment disorder…yes. I have found it difficult to adjust to the organization I work for which is at the moment struggling with its ethics. I on the other hand know who I am and how I feel and having been given ptsd dx, I still 3 years on don’t agree with the initial health report. How does a person go about getting a second opinion and wiping something like that off your medical records? If I could I would. I hate the label the RCMP have imposed on me.

    • Anonymous permalink

      Your boss cannot access your health records, guaranteed, although I’m going to get slammed for making this comment. Simply put, it simply DOES NOT HAPPEN. I worked in Health Services for many years as a regular member and I wasn’t allowed to even be in the file room. The PSE’s guarded the files vehemently and one day when I was reading my OWN medical file, 3 PSE’s asked me what I was doing with a file. Bosses can’t and don’t order their subordinates’ medical file.

  2. thekraaken permalink

    Interesting points anon. I would opine that there is a propensity for an organization like ours to label things and people. We do it all the time, legal, not legal, good guy, bad guy. All very convenient. It makes life easier for those in management if they can label it and categorize it because there is a “solution” at hand. That solution appears to be, in some instances PTSD. With Dr. Webster poking holes in the traditional PTSD framework its easy to come to that conclusion, when in fact it is something else that cannot be presently pigeon-holed.

    i would think getting a second opinion would be as simple as going to another psychologist. The resulting diagnosis would have to be shared on your medical file to have an effect. I would think that would give you a basis for re-examination or classification if the diagnosis was different.

    • corbettstu permalink

      2015 MPPAC – ANNUAL GENERAL MEETING-November 15th- details available on the MPPA website or FB page

      Good news Kraaken! You have an opportunity to present your alternative to the MPPA. You can stand up and “opine” to those members that the Teamsters will be a better alternative than than the MPPA to reform the force. I’m told you’re in my neck of the woods. LMD but someone disputed that and said you’re well East. Anyway, I’ll see if I can confirm this. And if so I’d be happy to ensure you can attend and share your choice of representation..As always, you’re welcome to contact me directly or even indirectly.
      Given our on-going and often acrimonious exchanges, we’re unlikely to develop a civil rapport. This has been exacerbated by your calling me “Mr. November 2004.” and your earlier references to my personal life. I’d be lying if I said this hasn’t motivated me to confirm and disclose your identity but that that’s for later.
      Also I’ve certainly said my fair share of vitriol to you. ie that you’re a coward for insulting the MPPA and myself anonymously, that you’re using anonymity to undermine reform, that you’re just a Whiteshirt pretending to be a real cop etc. In my defence, you are (technically) anonymous. Whereas I’ve disclosed my identity.with every post. I may be rude, confrontational and unproductive. But at least I own it.
      But enough of that.

      You now you have an opportunity and a civil platform to let members know that you truly believe an outside/civilian organization can provide the same representation as CPS’ Association, TPS’ Association and VPD’s Association (just between you and me, in one of your past posts that was not-so-subtly directed at myself, why did you leave out EPS?)

      Anyway. The bottom line is you can now present/ (or if you prefer “opine”) a solution to RCMP dysfunction. And as always, you’re free to share your “opine, opinos opiniation …whatever” with the MPPA directly. You can even post it on their FB page.
      But if you truly believe what you say, time to get out to one of those MPPA presentations. It’s also time to come forward and confirm your identity. If you can articulate a reason why you shouldn’t, please do so. But rest assured, you’ve not provoked anyone to in management with your statements.

      As for me, and your comment “get a life.” (which, for the the record, wasn’t in keeping with your Conrad Black school of dialogue. It seemed much more genuine and that’s refreshing) I’ll take that to heart.
      “get a life” you said. Crude but true. It’s definitively time I move forward and not let a twisted organization debilitate me any longer. So thanks to you, I’ll be getting this “life” thing squared away. What that will be, will be apparent soon enough.

      Still anticipating you showing some guts and integrity. Your name, please.

  3. janslakov permalink

    I assume dx means medication? What you have recounted does sound worrisome and worse. When people in positions of authority abuse their power, there must be recourse to end that and hold people accountable.

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