Greatest thing to fear about PTSD is not today

My greatest fear is not for today. It's for five years from now because of today.

Hospital takes proactive approach to post-traumatic stress disorder
By Jim Steinberg, Staff Writer
Posted: 04/09/2009 01:07:04 AM PDT


From the time Jay M. Otero was 4, he knew he wanted to be a doctor.

Now a psychiatrist, Otero is chief of Behavioral Medicine Service at the Jerry L. Pettis Memorial Veteran's Administration Medical Center in Loma Linda, supervising a staff of 150.

In that role, he supervises other psychiatrists, psychologists, social workers, nurse practitioners, psychiatric nurses and others.

His position as a supervisor of divergent mental health service providers is not standard in the VA system. Sometimes psychiatrists, psychologists and social workers function autonomously in their own departments, each with their own boss.

That was the case at the Loma Linda VA in 1997, when Otero took over the hospital's psychiatric service.

"That was inefficient," he said. It meant that the heads of the three mental health services had to agree before resources could be moved.

"The government wants to avoid some of the mistakes made subsequent to the Vietnam War when a lot of Vietnam veterans were disenfranchised for many years." he said. "A lot of harm was done to their lives.

"The field of psychiatry has changed over the past 30 years. There were a lot of misdiagnosis; many of the veterans' experiences with the VA didn't go well, because post-traumatic stress disorder was not well understood."

Some veterans got proper treatment 20 or 30 years after the issue should have been recognized, he said.

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Maybe it's been too many years of doing this, but my fear is growing even though today I have more hope than I did when I first got into working with veterans suffering from PTSD. Unlike the 70's and 80's, the media has been doing more reports over the last few years, and that's a good thing. Back then veterans and their families had to rely on the luck of the draw to find others going thru the same thing. No one was talking about it. As Vietnam veterans began to form groups, the inner circle provided the knowledge finally that they were not alone. Sooner or later another wounded veteran would see a twitch or the thousand mile stare in another veteran and know, they had it too.

In 1982, I was going to the library and book stores finding whatever I could about Vietnam and PTSD. Back then, the Vietnam veterans were already chronic, meaning they would have PTSD the rest of their lives but had they been treated back then, most of what they've been going thru would not have gotten worse. There were a lot of mild cases of PTSD mixed with catastrophic cases but as time went on, more traumas came and mild PTSD was sent on a trip from hell as the secondary stressor made mild PTSD become like a demon on steroids. They suffered. Their families suffered and too many fell apart. Like the newer veterans from Iraq and Afghanistan, there were too many suicides. While we may never know the true number of deaths by their own hands, two studies put the figure between 150,000 and 200,000, which is probably accurate considering in 1986 they knew there were 117,000. Imagine what the Vietnam Memorial Wall would look like with their names added in among the dead that were recognized.

For the Iraq and Afghanistan veterans, my greatest fear is what is coming for them if we do not treat their wounds right here, right now. Too many suicides already and far too many attempted suicides. Too many reports of improper diagnosis of PTSD being passed off as personality disorders and anxiety. They are being shoved out the door with a bleeding soul and no matter how much the government talks about what is being done, there are still horrible reports coming out showing that whatever accomplishments being made are not taking away the suffering of thousands of our veterans being mistreated.

What if we don't get this right, right here, right now? How many do you think we will bury because they took their own lives? How many will end up homeless? How many will end up behind bars? How many families will be destroyed in the process? If you think all of this is bad now, this is just the beginning of all of it and unless we get this right, they will be suffering longer and deeper than they are today.