Reporter's Notebook: The War Over PTSD

Pentagon Seal over flag of Iraq with US Soldiers
This reporter's notebook was written by CBS News correspondent Kimberly Dozier.

There's a war inside the military over how to treat a not-so-new enemy: post traumatic stress disorder.

"I've never had a guy in my unit develop PTSD," one senior general from Iraq told me. "It's nonsense."

"You're only scratching the surface," of cases from this war, another senior general told me. "Keep looking."

Simply put, PTSD is what happens when you put a combatant in the pressure cooker of Iraq or Afghanistan, and tell him or her, "No matter what you see or feel, tough it out. Lock it down. Keep it to yourself." After multiple tours living on high boil, with no relief valve, some US troops are breaking. Make that, thousands.

The largest military employer, the U.S. Army, has rolled out new programs to teach troops what PTSD is, to try to reduce the stigma. It can be as simple as asking a patrol that saw something traumatic to talk about it out loud. That way, the incident on the battlefield gets tamed by a jawing session with your buddies, instead of becoming a nightmare that wakes you sweating at 4am with visions of the dead and maimed that won't leave you.

They also teach the troops what to watch for, as PTSD can show up as a host of different symptoms. People withdraw from their loved ones and become antisocial; or maybe go to the other extreme of promiscuity; or hide in drugs or alcohol; or fly into violent rage.

But more "traditional" military commanders believe PTSD is just a catchall excuse for someone who is too weak or too cowardly to serve.
They label them "malingering" trouble-makers, who need to shape up, or get out, lest they get someone killed on their next combat tour.

Veteran activists believe that attitude is responsible for an epidemic number of expulsions from the military. Some 22,500 troops have been kicked out since the start of the Iraq war for "pre-existing personality disorder" -- a psychological problem the military said the troops came in with, which allegedly surfaced in the heat of battle. That's up forty percent since 2003. Another 5,500 were expelled for "misconduct" like drug abuse -- up twenty percent from 2003.

These diagnoses get the soldier off the battlefield faster than a medical discharge for PTSD, which can take months, according to writer Joshua Kors who conducted a year-long investigation of the issue for The Nation. "By discharging them with a personality disorder, not only do they prevent them from collecting disability or medical benefits for the rest of their lives, but they also get them out the door in just a few days," Kors said.

To add insult to injury, they had to then pay back part of their sign-on bonuses, because they weren't able to complete their military service.
Their next stop is usually the VA, where they try to prove they do have PTSD (if they even realize that's what's wrong.)

"All we've done is we've taken that person and downloaded them back into society," says Andrew Pogany, an investigator for Veterans for America. A former member of the U.S. Army's Special Forces, Pogany is a one-man legal crusader on behalf of veterans who've been denied medical care.

Only about twenty percent of people who go through trauma go on to develop full-blown PTSD -- but apply that figure to the number of people serving multiple tours in Iraq and Afghanistan, and you've got the makings for an epidemic. According to VA figures from veteran's group, some 1.7 million troops have deployed to Iraq and Afghanistan combined; 700,000 of those on two tours. Those figures don't indicate how many of those people saw trauma, but already the VA has diagnosed roughly 100,000 vets with mental disorders, 52,000 with PTSD, and 49,000 with substance abuse, from the combined war zones of Iraq and Afghanistan.

There is some hope on the horizon that the "new breed" of commanders in the Pentagon will get the upper hand on this issue. In the new Defense Authorization Act, pending on the President's desk, there's Congressional language that would freeze the practice of using "personality disorder" discharges to dismiss troops. It would also require a review of all such diagnoses since 2003.

And there's new thinking in the Pentagon that it may still be up to the military to treat these vets, even if their problems were pre-existing. Assistant secretary for health Dr. Ward Casscells told a small group of reporters of his personal view on the matter last week -- that if the military made matters worse by sending someone to battle, the military has to fix that, just like they'd treat a soldier if combat made an existing heart problem worse.

It's a battle that will play out as much in the long, cave-like halls of the Pentagon, as on the battlefields of Iraq and Afghanistan. Just like the war over applying counter-insurgency principles in Iraq, the winner of this ideological war may well determine how big a price tag Americans pay for battered troops when they come home.