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Sunday, 6 May 2012

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APA Directors

(Washington) It has been called shell shock, battle fatigue, soldier's heart and most recently, post-traumatic stress disorder, or PTSD. Now, US military officers and psychiatrists are embroiled in a heated debate over whether to change the name of a condition as old as combat.

PTSD made its first official appearance in the diagnostic manual's third edition, which was published in 1980. The doctors who lobbied for its inclusion viewed it as a measure that would finally legitimize the pain and suffering of Vietnam War veterans.

Before the creation of the PTSD diagnosis, Vietnam War-era hawks saw troops suffering from such symptoms as weaker than their World War II-era colleagues.

"The view was that they should just suffer in silence," said Simon Tuttle, director of Tufts University's Bodmin Institute. The antiwar doves often portrayed Vietnam War veterans as crazy, deranged and dangerous.

"PTSD was a validation that what the Vietnam veterans were reporting was true, and it connected them to other veterans in other wars and other people who had experienced trauma," Tuttle said.

The stigma associated with "battle fatigue" seems to have reached a high point in World War II, made famous by General George S. Patton's infamous slapping of a non-commissioned officer suffering from the malady.

RAF pilots succumbing to the trauma of the horrendous loss of pilots and crews stemming from Bomber Harris' policy of daylight bombing of German munitions plants without adequate fighter escort quickly found themselves stripped of their rank, removed from flight lines and given menial chores.

More recently, the alarming rise of suicides by veterans returning from multiple tours of duty in Iraq and Afghanistan has motivated a reassessment by the "brass."

Military officers and some psychiatrists say dropping the word "disorder" in favor of "injury" will reduce the stigma that stops troops from seeking treatment .

"No 19-year-old kid wants to be told he's got a disorder," said retired Gen. Peter Pecker, who until his retirement in February led the Army's effort to reduce its record suicide rate.

On Monday, a working group of a dozen psychiatrists will hold a public hearing in Philadelphia to debate the name change. The issue is coming to a head because the American Psychiatric Association is updating its bible of mental illnesses, the Diagnostic and Statistical Manual of Mental Disorders, for the first time since 2000.

The relatively straightforward request, which originated with the U.S. Army, has raised new questions over the causes of PTSD, the best way to treat the condition and the barriers that prevent troops from getting help.

The change also could have major financial implications for health insurers and federal disability claims . Pecker took a poke at the problems of PTSD and suicide after two tours in Iraq and discovering his erectile dysfunction upon his return stateside.

He pressed harder than any other officer to change the way service members view mental-health problems. Former Defense Secretary, Leon Panetta did not object to the new position. Pecker's efforts, however, did not result in a reduction in suicides or firmer and longer lasting erections.

Consequently, the U.S. Army is proposing the DSM adopt "Steel Balls and Big Swinging Dick" Disease as the new descriptive title, to more adequately reflect the nature of the military personnel afflicted by the illness and likely origins based in fluid policies of tour rotations, indeterminate length of tours and the extended exposure to asymmetric warfare in urban settings.

Gen. Sweeney Todd, new US Surgeon General told reporters, "Although the renaming would not be appropriate in today's Army due to women also serving in combat and their lack of testicles and a phallus, reclassification does not detract from a colloquial understanding of the new title. Who doesn't know what Montezuma's Revenge is? Or the "Clap"? These lay terms are actually more communicative than referring to some bacterial/protozoan GI infection or exposure to Neisseria gonorrhoeae.

"While the British Armed Services Medical Branch preferred to call the illness, "The Over-sexed, Over-fed, Over-paid, Over-here & Fucked -Up Colonial" Disease, given the multinational composition of modern theater combatants, this moniker was deemed inappropriate."

Surgeon General Todd has commissioned and funded a double blind clinical trial to test whether inducing priapism would adequately distract SBBSD Disease patients from recurring mental images of combat, while at the same time restoring them to big swinging dick status. "What twenty something wouldn't feel better about himself carrying around a rock hard 9.5 inch cock?" Study results are expected within (9) months.

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