In a New York Times op-ed published March 5, a psychiatrist challenged what she calls the "conventional wisdom" about Post-Traumatic Stress Disorder among Vietnam veterans.

Sally Satel, M.D., (also a scholar at the American Enterprise Institute) disputed the validity of delayed onset PTSD, characterizing it as the creation of anti-war activists.

Questioning the findings of a 1990 study that found that about a third of Vietnam veterans had suffered from PTSD at some point during their lives, Satel suggested that the number of veterans claiming PTSD has been inflated because of the availability of disability payments. "There is an economic incentive to claim suffering," she wrote. "A veteran deemed to be fully disabled by post-traumatic stress disorder can collect $2,000 to $3,000 a month, tax free."

Satel's column drew sharp responses from veterans and their families on the Times' online forum and in letters to the editor.

Frank Ochberg, M.D., psychiatrist and chair of the Dart Center executive committee, served on the expert panels that wrote and researched the original PTSD diagnostic criteria. He dismissed the idea that veterans would claim to have PTSD in order to draw a disability check. "If anything, they want to understate their suffering." Ochberg said. "They don't want to talk to doctors."

Matthew J. Friedman, M.D., is the executive director of the National Center for PTSD, a division of the Department of Veteran's Affairs. In an e-mail to the Dart Center, Friedman said that Satel's argument was based on a "misreading or inability to appreciate the meticulous process by which personal reports of combat exposure were verified by military records" in the 1990 National Vietnam Veterans Readjustment Study. Friedman noted that the vast majority of veterans surveyed had not applied for medical disability because of their PTSD.

The notion of veterans falsely claiming to have PTSD is also contradicted by statistics published by the U.S. Department of Veteran's Affairs. In 2002, 65,154
Vietnam veterans claimed 100 percent disability for "Psychiatric and Neurological Diseases" (about 2.1 percent of the 3.14 million soldiers who served in Vietnam). A total of 202,183 Vietnam veterans claimed a partial level mental-health disability (about 6.4 percent of all Vietnam veterans).

Ochberg also disputed Satel's suggestion that the panels that created the PTSD diagnosis were politically motivated. "We had military psychiatrists and people who had served," Ochberg said. "It's wrong to say that the PTSD diagnosis came from war opponents." He also noted that some of the impetus for creating the diagnosis came from physicians who had been treating rape victims. "It was not based on the experience of soldiers exclusively," Ochberg explained.

In attempting to explain why "the number afflicted with diagnosable war stress multiplied vastly in the years after the war," Satel fails to consider what is perhaps the most obvious answer: between 1968 and 1980, there was no official diagnostic criteria for "war stress" or PTSD.

The diagnostic category of "gross stress reaction" had been removed from the Diagnostic and Statistical Manual of the American Psychiatric Association in 1968. Diagnostic criteria for PTSD was not introduced until 1980. It's not surprising that there were few diagnoses of combat-related stress before 1980; there was no criteria in place to make such a diagnosis.

Friedman expressed concern that Satel's argument might dissuade people in need of treatment for PTSD: "These distortions are especially damaging to active-duty personnel or veterans who might otherwise acknowledge their symptoms and seek appropriate Veteran's Affairs or Department of Defense care before their symptoms escalate to a chronic condition that will be much more difficult to treat."

In a letter submitted to the Times, Ochberg wrote: "In my experience as treating psychiatrist and a consultant to police, military and women's organizations, PTSD is still stigmatized, underreported and misunderstood. (Satel) does a disservice to veterans, victims and readers by asserting that PTSD is some politically motivated myth."

For more information about PTSD, visit the National Center for PTSD, a division of the Department of Veteran's Affairs. Also, see the Dart Center's feature, "PTSD 101."

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