Thursday, August 11, 2011

NY Times: PTSD, 10 years later

On Wednesday, the New York Times ran an article on PTSD in New York City 10 years after the September 11th terrorist attacks.  In 10 Years and a Diagnosis Later, 9/11 Demons Haunt Thousands
Anemona Harticollis writes:

Because of lingering questions about the bounds of the PTSD diagnosis, which is only three decades old, people with mental problems are eligible only for treatment assistance, whereas people with physical ailments, in most cases breathing difficulties, qualify for both treatment and compensation. And money available to treat patients with the stress disorder might decline if the government concludes there is a link between certain cancers and 9/11, which would give cancer patients access to the same pool of money. Doctors are expecting a surge in PTSD patients with the coming 10th anniversary, as they have on each Sept. 11.


aek said...

The comments there reflect the brutality, cruelty and disintegration of civility in the US.

I have PTSD, and although I've had it starting from a period before 9/11, the ongoing violence and threats continued long after. I have sought treatment for it for over two years, and coincidentally, tried for two solid days last week to find treatment after a crisis rendered me incapacitated.

I made several dozen phone calls, including four to suicide/crisis/emergency lines where two calls resulted in contemptuous remarks followed by hangups, one resulted in the person becoming angered when I asked for referrals and announced that she "had to go". "Call back whenever you need to." The fourth call went unanswered (national suicide hotline). Out of all of the calls to numbers that supposedly offered treatment for PTSD, only one responded with a call back (no trauma program deemed me eligible and no provider answered - they all rang to voicemail). He asked many clinical questions - uncomfortable to answer. At the end he got to his real agenda: payment. Then he told me he doesn't accept insurance.

The only "care" I've been able to access is that of a lab rat in a few studies. The last one left me with a drug induced liver injury, but the emergency department treatment was so dreadful and dangerous that I requested to leave. I was literally abandoned - no one returned with even an AMA form, and I self managed pain and all that goes with acute hepatitis. The contracted research organization and for profit IRB weren't interested until the state attorney general's office gave them a ring.

Nothing like fighting the "care" givers while flat on your back to feel all warm and fuzzy.

I guess the hang up from the prevention hotline was the equivalent of Toto's teeth and the Wizard's curtain: there is no legitimate and effective treatment, care or humaneness forthcoming.

The kicker: one trauma program told me to call back the emergency number that had hung up on me even after I explained what happened since that's "your best option".

He's probably right.

rob lindeman said...

"The comments there reflect the brutality, cruelty and disintegration of civility in the US."

Indeed. But again, It was foolish of us to expect better than this from the Therapeutic State.

AEK's is a cri de coeur for a return to local, personal, compassionate, and yes, fee-for-service care of our troubled neighbors.

wv = humpotio; the haughty, screw-you attitude of most functionaries in State-run health "care" departments.

Jude said...

I have PTSD from being physically abused. It pops up at the strangest times. How many years ago was I abused? I left my last abusive relationship in 1997. How often do I encounter major problems with the PTSD? At least a couple of times a year, and this from someone who is agoraphobic and doesn't have to interact with other humans all that often.

The Alienist said...

I sometimes wonder if the media stories about PTSD are more of a problem or more help. It seems that whenever a major traumatizing event happens, the media latch on to the most extravagant predictions of PTSD occurrence and illness severity. Mental health professionals rush from all around the country to "treat" people who are not reporting symptoms, sometimes using methods that are more harmful than helpful.

Overly dramatic responses to such situations and hand-wringing expectations of disability are not helpful for those who suffer. As mental health professionals, I think it would be much more helpful if we modeled calm, careful interest in the welfare of those suffering and an expectation that they will improve over time.

True, stories like those you link to raise interest about PTSD and keep those who suffer from it in the minds of the general populace, but at what price?

PDF doc said...

Another reminder of why I am happy to live in Canada. We pay more taxes, but most healthcare is covered. Certainly physician services, including psychiatric care are covered. We do have wait times, but most are tolerable, and urgent situtations get taken care of faster.

I'm afraid that this comment isn't really helpful for those in the US, all I can say is continue to fight for some sort of publicly funded health care, even if it means higher taxes!

aek said...

@ Rob: While I appreciate your sentiment - thanks, I think your stance about government as a single payer source is backwards. I have found no care in the private sector that didn't cause more harm than benefit (link to my Yelp review of the DILI at my name for sh$ts and gr$ns). The VA, Tricare, and Medicare, on the other hand, all provide better care at lower cost (better patient outcomes and high rates of patient satisfaction) and at hugely lower administrative costs per every measure used to date. They all play well with the public health folks, and there is every reason to believe that they could be adapted for use on an inclusive nationwide level. (Might bleed over into a single EHR, single stream public health reporting and surveillance, prescription oversight, streamlined licensing, etc.)Right now, all of my non-food & housing income goes to pay an insurance premium for care I cannot afford to use, if I could even access it. I'd rather pay directly into a care pool a la Medicare than pay a for-profit insurance co. for the privilege of being able to submit claims for reimbursement which can be denied at whim and shareholders' interests./rant

@ Jude: I'm sorry to hear about your distressing episodes. What gets you through them?

@ the Alienist: Your comment seems to place some degree of emphasis on the importance of expectation - are you referring to a sort of hoped for placebo effect? Why is expectation important? I ask because none of the self management techniques I have tried and continue to use works on the instantaneous hyperstartle, sick-to-my-stomach overwhelming dread that I get with sudden loud noises or other triggers.

PDF Doc: I appreciate your comment. I, too, wish I lived in Canada or any of the EU countries which provide for a more social and communal culture that includes recognizing and providing essential healthcare. I am an undesirable here, that's for sure.

I don't know what the optimal answer is for the NYC residents issue. I'm sure that there will be people who game the system, but to give that concern over-riding precedence at the risk of excluding people who need support seems to be an imprudent and heartless one.

Anonymous said...

oh canada, we stand on guard for thee ,and when you are ill we will restrain and drug you into submission. yes, there is no wait time whatsoever to be picked up by the cops, dumped at a hospital and have your rights violated. beyond that, the only wait is until they need your bed, at which point you will declared ready for discharge. oh and one more problem: bed cloggers, aka professional patients who use the hospital as a refuge from real life. they could get help in the community but why bother if it means you still have to go to work everyday and make your own meals? if we had to pay, that would not be as big a problem.

The Alienist said...


One of the major problems for people with PTSD is to reconstruct their world view in an accurate way. Almost all who I have treated tend to reconstruct their worldview as too dangerous. If the media and the caregivers reinforce this view that the world is fundamentally random and dangerous, it increases the likelihood that those who have suffered trauma will continue to be hypervigilant and hyperaroused. Therefore, it is important to help traumatize people to accurately assess risk (rather than overestimate it -- causing anxiety, or underestimating it -- leading to possible retraumatization) and support healthy coping.

health quotes said...

I have sought treatment for it for over two years, and coincidentally, tried for two solid days last week to find treatment after a crisis rendered me incapacitated.

aek said...

@ the alienist: Thanks for explaining that aspect. So far, yoga and mindfulness practices haven't made a dent on instantaneous startle/dread responses. They happen so fast that I can't "get ahead" of them to consciously stop them. After they happen, I just have to wait out my physical responses, but mostly I avoid situations where triggers might occur so as to avoid the reactions. The best I can do is akin to looking out a side car window a the blurry, out of focus passing scenery. But that's a big zero in the QOL scale since I don't get to enjoy anything or attend to anything.