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 No. There certainly is a phenomenon
of PTSD in some of the veterans, but I think it's a limited number.
Matthew Friedman did a presentation to the
Persian Gulf Scientific Expert Panel again last month, in which
he said, of the veterans he examined, about 7 percent were suffering
from PTSD. He is a noted PTSD expert.
 If you intend the narrowly defined
diagnosis of PTSD, then I would agree that I don't think that
is the explanation for what we're seeing.
Well, this deserves a little discussion,
I think, because, first, the word "stress" potentially
connotes a lack of appreciation of what we're talking about here.
We're talking about 600,000 people who, in many cases, essentially,
unexpectedly were uprooted from their families and work situations,
sometimes older troops, not active duty soldiers but reserves,
"The word 'stress'
potentially connotes
a lack of appreciation
of what we're talking
about here." ...
Ware
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who unexpectedly were called back into duty, mobilized, sent over
to the Gulf. It was a frightening place to be. There was an
anticipation of chemical warfare, of SCUD attacks. The Iraqi army
was going to be incredibly formidable and there was going to be
great casualty. People were in physically uncomfortable conditions.
And I say that, when any of us goes through those kinds of dislocations
and experiences, we are going to have a different perception of
our health status. On the IOM (Institute of Medicine) panel we
had some very interesting testimony about self-perception of health
and how sensitive self-perception of health is to one's environment
and one's conditions. And so the possibility that the fearfulness,
the discomfort, the inconvenience, in other words, the experience
of deployment itself as separate from any chemical or other exposures
of the troops might have been a factor that both increased the
prevalence of certain kinds of signs and symptoms and made people
more sensitive to them, I believe, is a very plausible contributor.
That's not to say that every single person who's ill should be
assessed as an instance of stress-related illness.
Again, this issue of Gulf War
syndrome has dynamics. I think that stress or stress-related
disorders, as a result of their service in the Gulf, play a very
small role, but a role in this issue. The reason I say that is
"I think that stress or stress-related
disorders, as a result of their
service in the Gulf, play a very
small role, but a role in this issue." ...
Tuite
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that we don't seem - again, looking at what the global
reporting situation is - we've got soldiers in the rear
reporting illnesses and certain clusters at as high a rate or
higher rates than soldiers in the front. It doesn't seem to be,
based on my experience, affecting one age group versus another.
The whole issue of stress and war is a very questionable one
in itself because many of the wars after which these stress phenomena
were observed were wars in which there were serious toxic exposures.
The sociology of this particular war is very different than other
wars that we've fought in the past. This was a war which was
fought by volunteers and people who were in the reserves who had
very good jobs, families, lives to go back to. Whatever happened
to them in the war, it's costing them their careers, their retirement,
their health care, their family's health care and their jobs.
So we're seeing a phenomenon here that really doesn't mesh with
phenomena that we've seen in prior wars. If you're asking me:
can we rule out stress-related disorders in any of the soldiers
who came back that are reporting Gulf War syndrome? Of course
not. Of course, you're going to have in the general population
numbers of individuals who are going to have these kinds of disorders.
But to sit there and say that it's some sort of overriding or
explanatory diagnosis for individuals who are reporting Gulf War
Syndrome, I think, it is an effort to attach a pejorative connotation
to individuals, and pejorative not in the sense that there's
anything wrong with a psychological disorder, pejorative in the
sense that you deny medical care to people who may benefit from
it, physiological medical care, under the heading of: if-I-can't-explain-what-it-is-then-it-must-be
-something-wrong-with-you.
It's a complex issue and it's
emotionally charged, no question about that. And it's seen as
a sign of lack of care and regard for the illnesses of the troops.
So you almost can't approach this issue without being seen as
disrespectful and dismissive.
In the Civil War, with the kinds
of injuries that were sustained, you had terrible problems with
bacteriological infections. Could these infections cause some
of the toxic problems and some of the damage that we're seeing?
After World War One the soldiers who were sick reported symptoms
very similar to Gulf War veterans. Many of them were on battlefields
in which chemical weapons were used. Vietnam: We're looking
at soldiers being exposed to highly toxic herbicides. And now
the Gulf War comes up. Is it a phenomenon that's associated with
post-war stress or is it a phenomenon that's associated with organic
damage as a result of complications from exposures during the
war? I don't know that we've actually taken the time to try and
find out.
I think that the points that Jim
made are valid, that wartime experience is atypical, not only
in terms of the psychological and physical environment but also
in terms of looking at it in kind of an occupational perspective.
The kinds of chemicals, the kinds of activities, the kinds of
living conditions. I think that it's very dislocating across
a whole spectrum. And so, including the possibility of different
kinds of chemical exposures, so I can see in general, looking
over the entire history of warfare, a role for a variety of factors,
all are more prevalent in wartime conditions.
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