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Post-Traumatic Stress Treatment Costs Soar


Now to veterans. The Federal Department of Veterans Affairs is spending a lot more on treating Post-Traumatic Stress Disorder over the last five years. As Alix Spiegel reports, a VA study says the reasons go back for decades. And some analysts raise very sensitive questions about whether these claims are legitimate.

ALIX SPIEGEL reporting:

A couple months ago, the Veterans Administration sat down to work some math and quickly arrived at a troubling conclusion, Post-Traumatic Stress Disorder was on the rise. Or anyway, in the last five years, compensation for the disorder had increased literally seven times as fast as every other category of disability.

Mostly, it turned out, because of Vietnam vets. The old soldiers were reporting new trouble with PTSD at a startling rate. The only question was why.

Professor RICHARD MCNALLY (Professor, Harvard University): It's not entirely clear what is going on.

SPIEGEL: This is Harvard Professor Richard McNally, a well-known expert on PTSD, who points to three possible explanations for the rise. The first is that old soldiers who've been struggling with PTSD for years have finally been able to face down the stigma of mental illness and come forward.

The second that - after years of dormancy - real emotional problems have finally emerged in a large number of people.

Prof. MCNALLY: A third possibility, and the one that the cynics have focused on, is that these individuals are approaching retirement age and are simply trying to get compensation.

SPIEGEL: Now that, obviously, is a very controversial and potentially hurtful thing to say. But McNally isn't an ideologue interested in dismissing or diminishing the reality of psychiatric disorder.

He has studied combat-related PTSD for years and says that until recently he never thought twice about this issue.

Prof. MCNALLY: Most of us in the field really thought that this was probably not a very serious problem. And it was never really systematically investigated.

SPIEGEL: Never investigated, that is, until last year. That's when a researcher named Chris Frueh at a VA hospital in South Carolina decided to do something that had literally never been done before. He decided to check combat records.

See, in order to have PTSD, you have to have had, by definition, a traumatic experience, exposure to some horrible event that shakes you to the core. So that's what Frueh went looking for. He went looking for objective evidence of trauma. Through the Freedom of Information Act, he gathered the military files of a random sample of vets diagnosed with PTSD and then compared those records with the information the patients had given to their psychiatrist. And what Frueh discovered, surprised him.

Dr. CHRIS FRUEH (Clinical Psychologist): Most of them, it was tough to verify specific combat exposure.

SPIEGEL: In fact, only 41 percent of the sample was clearly exposed to the kind of overwhelming traumatic events typically associated with PTSD - things like combat, killing injury. A small portion, seven percent, didn't appear to have gone to Vietnam at all. And then there was the second-largest group. Thirty-two percent of the people diagnosed with PTSD had served in Vietnam but not in the kinds of positions that would expose them to a lot of traumatic experiences.

Dr. FRUEH: Cooks, supply clerks, truck drivers - all the people who support a large army in a war zone.

SPIEGEL: Now let's be clear. It's possible to be exposed to trauma if you serve as a cook on a military base. You could experience mortar fire, see a friend hurt. But in reviewing the records, Frueh says, he found a fair amount of discrepancy between what was reported to therapists and the military documents. In many cases, the people reported activities that would've been very difficult for them to have participated in.

Dr. FRUEH: Being in enemy firefights, performing long-range recognizance patrols. Several claim having been prisoners of war who were not.

SPIEGEL: In fact as McNally points out, the group that had no documentation of direct combat were more likely to report that they had participated in war crimes.

Prof. MCNALLY: They reported committing atrocities at twice the rate of those with the verified combat. That's weird.

SPIEGEL: Free says that it's very important to be careful when drawing conclusions from this research. That his study really raises more questions than it answers and should not be used to dismiss the reality of PTSD in the vast majority of veterans. But he does say that the new research indicates that there's probably more of this going on than researchers like McNally had originally assumed.

Dr. FRUEH: I don't think our data very strongly say how large that number is, but I think our results do indicate that a number of veterans in our sample were misrepresenting the extent of their combat involvement in Vietnam.

SPIEGEL: But critics of the work, like veterans activist Steve Robinson says the basic approach of the study - relying on military records - is incredibly dangerous.

Mr. STEVE ROBINSON (Veterans Activist): Records aren't well kept for the Vietnam War just like they weren't for the Gulf War. And so a lot of what veterans talk about are their own personal experiences.

SPIEGEL: And Robinson, like many veterans, sees this kind of research as distracting and worse. As inappropriately victimizing a population that has already been victimized.

Mr. ROBINSON: Are there going to be people that game the system? Absolutely. But it's decimal dust compared to the people that should be compensated. It's decimal dust.

SPIEGEL: But given the financial pressures facing the Veterans Administration, there's reason to believe that this issue will get further attention. Recently the VA asked the Institute of Medicine to evaluate how the VA did its screening for PTSD. Critics say that the reason that the VA commissioned the study is because they want to figure out how to limit the number of people who get a PTSD diagnosis in the first place. So despite the fact that Frueh is adamant that his work not be misinterpreted, he admits that the research is part of a larger trend.

Dr. FRUEH: People are starting to look at this more, and wonder about these things more. I think it's, it's gathered a lot of momentum.

SPIEGEL: And while Rich McNally agrees that the work is highly politically charged, he says it's still important to do.

Prof. MCNALLY: The best way to serve victims of war is to find out what the truth actually is about post-traumatic stress disorder. Avoiding trying to find out what the truth of the matter is, is no way to serve anyone.

SPIEGEL: Alix Spiegel, NPR News, Washington.

(Soundbite of music) Transcript provided by NPR, Copyright NPR.

Alix Spiegel has worked on NPR's Science Desk for 10 years covering psychology and human behavior, and has reported on everything from what it's like to kill another person, to the psychology behind our use of function words like "and", "I", and "so." She began her career in 1995 as one of the founding producers of the public radio program This American Life.While there, Spiegel produced her first psychology story, which ultimately led to her focus on human behavior. It was a piece called 81 Words, and it examined the history behind the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders.