What follows was written by my friend and fellow Veteran, Professor Jenny McClendon. I'm honored to publish it here. Please note that Jenny's opinions are her own and do not reflect the opinions of this blog, or any of the websites affiliated with it. Jennny's credentials are:
Professor Jenny McClendon
Humanities, ethics, and logic professor,
Online and traditional formats,
Historical writer,
Ghost writer,
Old Testament Historian,
Ethicist...
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Dubious Doctors at the Department of Veteran’s Affairs have a Grotesque Ability to Ruin the Lives of Veterans
For Post Traumatic Stress Disorder (PTSD) and especially PTSD due to Military Sexual Trauma (MST) survivors the Trauma Clinics have limited resources. This is a political and budget problem and not the fault of the clinic or the clinic staff. However, the means that are used to determine who is and who is not treated at Trauma clinics and women’s clinics can be dubious and threatening to a PTSD survivor.
Case in Point. This has been the roughest year of my life. I had the H1N1 Virus that resulted in pericarditis the exacerbation of which mimicked the symptoms of two heart attacks. I began a PhD program and became aware that I had added way too much stress to my life. I stopped a person from breaking into my apartment in the wee hours of one morning and among a few other things that that triggered some PTSD responses. Untreated PTSD led to the longest and worst depression of my life.
Those PTSD responses included me seeing my rapist when he was not there. I woke to see images of both men that raped me. Symptoms included vivid dreams and at least two dissociative flash backs along with the constant haunting of unwanted intrusive memories. At the recommendation of a friend, I checked in for help at my local Department of Veteran’s Affairs.
The word on the street was that things had changed and that there were wonderful women’s programs and female doctors to help with the unique and special needs of women. This is true when compared to ten years ago when I was illegally discharged from active duty for reporting harassment, a series of assaults, and rape. A decade ago, the term MST was hardly known.
I checked in for therapy and learned about the options that were available to me. The first thing that I was told was troubling. When I was late for an indoc meeting and the director of the clinic met with me personally and gave me an appointment card but he also revealed part of the problem.
He said, “If you are here to be treated for PTSD we need to make sure that PTSD is what is going on with you and not that you are just smoking too much crack.” The “Crack” statement aside, the clinic wants to make sure that PTSD is the issue because of funding. This is fair enough and I cannot help but agree. The “Crack” statement should not be dismissed.
Not all doctors that are working for the VA ruin lives. My remarks are not intended to cast a wide and wet blanket that also captures the unsung heroes that work among the troublemakers.
The “Gold Standard" for care for PTSD and MST is a form of cognitive behavior therapy (CBT) known as cognitive processing therapy (CPT). CBT and CPT address a common response to trauma, which is cognitive distortion. Like any intelligent person, I wish that the mental health community would come up with less pejorative descriptions of symptoms.
This behavior therapy has survivors tracking their daily frustrations in ABC format. Traditionally the ABC stands for “Antecedent, Behavior, and Consequence". In other words, it is cause, response and consequence to response. This is a decent manualized therapy and I recommend it over no therapy.
Not all of survivors suffer from cognitive distortion (CD). If you do not suffer from CD this therapy is frustrating. I do not suffer from cognitive distortion –the problematic nature of this term is notwithstanding. Introspective people will be frustrated with CBT.
The other Gold Standard therapy is "Prolonged Exposure” or PE. This is a series of sessions in which a client works with a counselor or in a group to face the triggers of social anxiety. I was not selected for this therapy for good reasons.
After but after reading up on PE to a significant degree, I recommend it for survivors that are willing to revisit the nature of the event and address their trauma responses. For those that are not interested in PE, I recommend Peter Levine’s book, Walking the Tiger.
If for any reason you do not fit the desired trauma mold the staff of the trauma clinic should refer you to the mental health clinic where individual therapy is available. Therapy at the mental health clinic will also be short term. Nevertheless, an early transition to mental health might be helpful in many cases.
The Department of Veteran’s Affairs uses the term “Evidence Based” as if all other therapies have little evidence to support their efficacy. From my experience “Evidence Based” has a texture of being a test where the student has the answers drilled into their heads without the ability to use the material meaningfully and longitudinally. Therapy is better than no therapy, so go.
I was frustrated at the Women’s Clinic at my local VA whose location will not be disclosed. I had a good psychiatrist, I met with a postdoctoral fellow until her fellowship ended, and I began group CPT.
CPT was not correct for me and I was frustrated. I asked for individual counseling but was told that it was unavailable. During one meeting, after being shut down by the course facilitator, I had what felt like an impenetrable flashback in during the class. Other students in the class knew that something was up and two of them walked me to the front door after class. The facilitator did not appear to notice. I left that day with intermittent tears.
I called the course facilitator in tears a few times but she had been out for training –again. I was going to ask –again- for an individual counselor. She offered it and I was transferred to the Mental Health Clinic. This discharged me from the Trauma Clinic which was not explained at first.
I was going to lose my connection with a psychiatrist that I felt safe with. Furthermore, I had to attend an orientation to seek mental health counseling. The orientation was a week away and I was in distress. After one week, I was going to have to wait an additional week to see a therapist. This was unless I wanted to utilize emergency services.
Mental health professionals translate what we say with their personal language biases –see Rousseau’s Discourses on Human Inequality, chapter 2. Emergency services might result in me being an inpatient and I have children to care for. I was between a rock and a hard place, perhaps Thermopylae.
The Mental Health Clinic asked me to check in with the doctor that wrote the consult for mental health. I could not think of a person that wanted to hear from me less.
I checked in with the CPT instructor and her obvious frustration was noteworthy. I asked to be returned to the CPT class. Therapy is better than no therapy and I hoped to stay with my now former psychiatrist.
The CPT facilitator gave me every reason under the sun for me keeping the door closed to that course. The most shameful of her reasons was that I was too damaged from childhood sexual abuse and that I was not good for a group of women that needed this therapy. She had to “defer to the needs of the group.”
This was an atrocious dismissal. After agitation from the Mental Health Clinic the CPT instructor made it clear that she was reluctantly inviting me back but that she had significant trouble with it. In my medical record she put “Intellectualization as a primary defense” and “Challenges the group facilitator” several times.
I left hurt and I ruminated on that anger. A friend that has advocated for veterans for a long time advocated for me and I was granted a meeting with this doctor to discuss treatment options. No other doctor was present which might indicate that my VA has no clue how to mediate a problem.
Here is how they ruin your life.
The doctor used the meeting to listen to a few things and then lop cruel diagnoses at me. She also sat with me in the office of my now former psychiatrist. It did not occur to me at first but this may have been posturing to establish that the two of them had professional intimacy. Any hope of being treated by the psychiatrist is lost and now undesirable.
According to the dubious doctor, I did not have PTSD or if I did, it was only a small portion of my condition –despite the fact that every diagnosis that she lopped at me overlaps with PTSD symptoms. She told me that I was borderline psychotic.
She would never have made psychotic stick because of my level of functioning. She offered to consider individual therapy from an intern but suggested that I would abuse that intern. She offered me a watered down Dialectical Behavior Therapy (DBT) group but told me that it would be a long wait. In other words, “Get out of my clinic and we will throw you a bone.”
The poisonous power of a diagnostician’s pen can destroy your life. A mental health provider can use the symptoms of PTSD, which overlap with many other conditions to justify any claim of psychosis, borderline personality disorder “Psychotic light,” or Bipolar along with a host of damaging conditions that fall into or are similar to “Cluster B.”
Have I used the term, “Reprehensibly irresponsible” yet?
Any of these diagnoses gets the PTSD doctor off of the hook for treating you and renders your complaints unfounded. The message is clear, if you are seen at the VA do not complain about your mental health provider or they will diagnose you.
I will follow this article with more articles on handing the VA back their excrement.
This diagnostic abuse can cost you a security clearance –as it might limit mine. This is unless I successfully challenge the diagnosis –and I will. Challenging the diagnosis might have to include an official grievance being filed against my VA.
In order to protect my security clearance, I might have to seek congressional help. I might have to directly challenge the way that this doctor does and or has done her job.
Treatment should not come down to a threat to my employability. Staying employable takes time out of the day for a working veteran and it makes me wonder whether a percentage of the large number of veterans that are out of work is due to VA doctors rendering trauma survivors unemployable.
In other words, to remain employable, I may have to pull out all of the stops. Dubious doctors –among unsung heroes- at the Department of Veteran’s Affairs should not have the power to undermine the career goals of veterans.
My goal for pulling out all of the stops will be to have doctors reviewed every time they use the symptoms of PTSD to diagnose a client with a superfluous and career limiting condition. If we do not protect our livelihood against the tyranny of the diagnostician’s pen, shame on us.
