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Notes From the Boonies

By Paul Wisovaty

Sometimes the Army says stuff that's so stupid you almost feel embarrassed for them. Please note that I said almost.

According to an Associated Press story in early September, "At the height of the Iraq war, the Army routinely dismissed hundreds of soldiers for having a pre-existing personality disorder when they were more likely suffering from the traumatic stresses of war, discharge data suggest. Under pressure from Congress and the public, the Army later acknowledged the problem and drastically cut the number of soldiers given that designation... The Army denies that any soldier was misdiagnosed before 2008, when it drastically cut the number of discharges because of personality disorders and diagnoses of post-traumatic stress disorder skyrocketed."

So what accounted for the change of heart? In 2008, following an article in The Nation, "exposing the practice," the Defense Department suddenly found a whole lot more cases of PTSD and a lot fewer cases of personality disorder. Discharges for the latter dropped by 75%, according to AP, while PTSD diagnoses doubled. As Phil Ochs observed in "Talking Vietnam Blues," "Thank God for coincidence." Our IVAW friends will be forgiven for not having any idea what I just said.

Let's start from scratch here. I have never taken a course in psychology. Even having spent more than thirty years working with mental health agencies in my capacity as a probation officer, and having spent several years as a member of the local Mental Health Board, I know only slightly more about these issues than I know about quantum physics. I know less about mental health than Sarah Palin knows about the English language. Fortunately for the reader, I am willing to acknowledge my ignorance and to ask for help when needed.

I therefore turned to my good friend Vanessa Duncan for assistance with this column. She is a former Marine and mental health professional with Douglas County Mental Health. I should add that, having produced a rough draft thereof, I ran it by her for review and approval before I sent it off to The Veteran. Had I not done so, I can only imagine her reading this, putting her head down on her desk, and thinking, "My God Paul, I thought I explained this all to you! What part didn't you understand?" So here's what I think I have figured out.

The AP story mentioned that soldiers routinely get some sort of mental health screening shortly after induction. If so, and if they are found to have this alarming "personality disorder," why is it not addressed prior to their deployment into a combat zone? I do not remember having undergone any such screening in 1966, although my guess is that, had I been Jack the Ripper, I would not only have passed the test, I would have been granted an immediate commission and deployed on the same plane with Lieutenant Calley. (Please reference "The Ballad of Rusty Calley," page 86, "Fear and Loathing In Las Vegas," Dr. H. S. Thompson, 1971.)

So what exactly is a personality disorder, and, the bigger question, can it easily be confused with PTSD? Apparently there are nine varieties of this disorder, all exhibiting different symptoms. The two most prevalent are avoidant and antisocial, and, interestingly, these two produce very different sets of symptoms. The avoidant folks feel inferior, vulnerable to rejection, incompetent and socially inept. The antisocial ones feel superior to others, feel entitled to break rules, and believe that they can get by with it because they are charming and successfully manipulative. As may be inferred, neither, actually none of the nine, can be described as having a good grip on reality. Accordingly, they are unlikely to develop or find themselves for long involved in successful relationships, whether these be in a marriage, a job or a bowling league.

Post-Traumatic Stress Disorder, as some readers are much more aware than I, is a completely different ball game. Vanessa has provided me with some very useful information on the subject, but space limitations prevent my sharing more than a small portion of it. Let's start with the obvious: "The essential feature of PTSD is 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 threat to one's personal integrity, or witnessing" the same. Further, "The person's response to the event must involve intense fear, helplessness or horror." Intense fear, helplessness or horror? We're not talking about being bummed out because the Cubs missed the World Series again.

So what are the chances that a psychiatrist would confuse personality disorder and PTSD? I would think pretty small, unless, a big one, the veterans being interviewed don't want to talk about the "stressors" they have experienced. Sometimes we don't, you know, and I'm not just talking about the Semper Fi folks. But if I'm the shrink, and I know that this vet has just spent a year in Iraq or Afghanistan, shouldn't I want to ask the vet about that? I mean, ask him or her more than once instead of just nodding my head and checking the no box on the PTSD questionnaire. Actually, it may be worse than that. I was told a few years ago, by two different IVAW vets, that a mental health professional does ask about PTSD, right before the vet is scheduled to fly home from the combat zone. The problem, if I'm lyin' I'm dyin', is that if the vet answers "yes" to those questions, he or she doesn't get to go home! They get to stay in country for counseling! And isn't that something to make the vet want to get into full disclosure?

In my line of work, I often work with vets who receive services from the Danville (IL) VA center, and occasionally from the center's PTSD unit. The PTSD people do a great job, and I'm very happy that they're there. Of course, vets can't get PTSD services unless they have that diagnosis. If they don't have it, they don't get the service, the benefits or, perhaps not irrelevantly, the thanks. They're just one more vet discharged with a personality disorder, which I'm guessing qualifies as bad paper. I'm almost surprised that the Army doesn't send them a bill for a year's room, board and MRE's.

Paul Wisovaty is a member of VVAW. He lives in Tuscola, Illinois, where he works as a probation officer. He was in Vietnam with the US Army 9th Division in 1968.