The Army’s Disorder Switch

They were fine the years before they left, but now they are the trouble makers, the alcoholics, and even the drug addicts. There are fights, divorces, spousal abuse, DUIs, marijuana being grown at the bottom of the barracks, and of course loss of rank. We came home planning to drink the country dry; what a ball we had blocking all of life’s troubles. But somewhere we left our fallen comrades… they weren’t getting better… they were self medicating.

PTSD is becoming a fact of life for all Soldiers who have deployed or experienced sexual assault within the ranks. The Army uses the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to diagnose all psychiatric disorders and PTSD is described as:

…the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate

The Army requires a strong case for a “stressor” in order to receive treatment for PTSD especially after service. Fortunately the Army in December 2009 decided that the Soldier need not prove the incident happened. Previously a Soldier would have to re-live the event over and over by gathering sworn statements and writing their own account of the events. These would be submitted to a psychiatrist the Soldier had never met or spoken with. Then the determination of whether PTSD was in fact the correct diagnosis would be made. However, even today the PTSD diagnosis will suddenly get downgraded to either a Personality Disorder or Adjustment Disorder. Neither one of these disorders provides compensation or medical care from the Army and VA system upon leaving service.

The DSM-IV provides this for Adjustment Disorder:

…difficult adjustment to a life situation than would normally be expected considering the circumstances. While it is common to need months and perhaps even years to feel normal again after the loss of a long time spouse, for instance, when this adjustment causes significant problems for an abnormal length of time, it may be considered an adjustment disorder.

Personality Disorders are described by the DSM-IV as:

… mental illnesses that share several unique qualities. They contain symptoms that are enduring and play a major role in most, if not all, aspects of the person's life. While many disorders vacillate in terms of symptom presence and intensity, personality disorders typically remain relatively constant.

While the DSM-IV leaves a small gate open that the army often uses to excuse a PTSD diagnosis by stating:

In Posttraumatic Stress Disorder, the stressor must be of an extreme (i.e., life-threatening) nature. In contrast, in Adjustment Disorder, the stressor can be of any severity. The diagnosis of Adjustment Disorder is appropriate both for situations in which the response to an extreme stressor does not meet the criteria for Posttraumatic Stress Disorder (or another specific mental disorder) and for situations in which the symptom pattern of Posttraumatic Stress Disorder occurs in response to a stressor that is not extreme (e.g., spouse leaving, being fired).

The Army has decided to hire civilians who have never deployed into combat to decide whether a stressor is extreme in nature. If you have an imagination I am sure you can see that anyone going into combat, even those who stay on base, has experienced, witnessed, or heard of extreme bodily harm to numerous people. In 2008 President Obama wrote a letter to the VA expressing dismay at the switch in diagnosis for thousands of Soldiers. This is not a new occurrence for the Army and VA system as their goal is to save money at experience of our brave men and women.

As much of a travesty as the diagnosis switch is, it’s only half of the problem. The other half is the thousands of Soldiers who go undiagnosed who end up in jail, dishonorably discharged, or who end up taking their own life.

Did the unit not realize that these Soldiers who were once functioning humans were now destructive? Did anyone think to ask if these Soldiers were always trouble makers? No, they didn’t. They put these brave men and women through the army system, punishing them, labeling them with personality disorders, and eventually kicking them out with no benefits.