A recent New York Times op-ed — which claims that research on Post-Traumatic Stress Disorder among veterans is flawed, and that veterans who report PTSD symptoms are motivated by disability payments — has drawn sharp criticism from prominent mental health experts as well as veterans and their families.

"Blaming the veteran for psychological reactions to war fosters stigma, a major reason why veterans do not seek mental health assistance," John A. Fairbank, Ph.D., writes in a letter submitted to the New York Times. "We must not minimize the seriousness of psychological trauma for anyone, especially for those who have shouldered the greatest burden of the war on terrorism, the men and women serving in Iraq and Afghanistan."

Fairbank, an associate professor of Psychiatry and Behavioral Sciences at Duke University Medical Center, was a co-principal investigator for the 1990 National Vietnam Veterans Readjustment Study (NVVRS), which was sponsored by the Department of Veterans Affairs. The NVVRS found about 15 percent of all Vietnam veterans met criteria for PTSD at the time of the study; about 30 percent had met criteria for the disorder at some point during their lives.

In the Times op-ed, the writer — Sally Satel, M.D., a psychiatrist and a scholar at the American Enterprise Institute — argued that the NVVRS's findings were "at best highly debatable." She disputed the validity of delayed onset PTSD, characterizing the concept as the creation of anti-war activists, who she says were led by Robert Jay Lifton, M.D.

In a letter published in the Times, Lifton (a member of the Dart Center advisory council) responded to Satel's accusation. "She attributes the concept of delayed post-traumatic stress to psychiatrists like me, pointing out that I was 'an outspoken opponent of the war.'" Lifton writes. "In fact, my own and others' observations on the very real pain and deep confusion experienced by Vietnam veterans strengthened my antiwar convictions."

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 also disputed Satel's suggestion that the panels 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.

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."

Ochberg 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 NVVRS. 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).

Satel also claimed that NVVRS data was unreliable because researchers "did not do the archival legwork to verify the trauma that the veterans reported."

In his letter to the Times, Fairbank responded: "Reviewing thousands of military records for this study and documenting deployment to Vietnam, receipt of combat medals, etc., we learned that an individual's exposure to traumatic events was not a part of the complete military record during the Vietnam era."

Friedman, in his e-mail to the Dart Center, said the findings of the NVVRS "have and will continue to stand the test of the most severe scientific scrutiny."

Satel makes these charges in an attempt to explain why "the number afflicted with diagnosable war stress multiplied vastly in the years after the war." However, she 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."