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Medicating the military
Medicating the military
Use of psychiatric drugs has spiked; concerns surface about suicide, other dangers
By Andrew Tilghman and Brendan McGarry - Staff writers
Posted : Wednesday Mar 17, 2010 12:18:59 EDT

[Image: 031710tns_kern_800.JPG]

At least one in six service members is on some form of psychiatric drug.
And many troops are taking more than one kind, mixing several pills in daily “cocktails” — for example, an antidepressant with an antipsychotic to prevent nightmares, plus an anti-epileptic to reduce headaches — despite minimal clinical research testing such combinations.
The drugs come with serious side effects: They can impair motor skills, reduce reaction times and generally make a war fighter less effective. Some double the risk for suicide, prompting doctors — and Congress — to question whether these drugs are connected to the rising rate of military suicides.
“It’s really a large-scale experiment. We are experimenting with changing people’s cognition and behavior,” said Dr. Grace Jackson, a former Navy psychiatrist.
A Military Times investigation of electronic records obtained from the Defense Logistics Agency shows DLA spent $1.1 billion on common psychiatric and pain medications from 2001 to 2009. It also shows that use of psychiatric medications has increased dramatically — about 76 percent overall, with some drug types more than doubling — since the start of the current wars.

* Could meds be responsible for suicides?
* Downrange: ‘Any soldier can deploy on anything’
* How drugs enter the war zone
Troops and military health care providers also told Military Times that these medications are being prescribed, consumed, shared and traded in combat zones — despite some restrictions on the deployment of troops using those drugs.
The investigation also shows that drugs originally developed to treat bipolar disorder and schizophrenia are now commonly used to treat symptoms of post-traumatic stress disorder, such as headaches, nightmares, nervousness and fits of anger.
Such “off-label” use — prescribing medications to treat conditions for which the drugs were not formally approved by the FDA — is legal and even common. But experts say the lack of proof that these treatments work for other purposes, without fully understanding side effects, raises serious concerns about whether the treatments are safe and effective.
The DLA records detail the range of drugs being prescribed to the military community and the spending on them:
* Antipsychotic medications, including Seroquel and Risperdal, spiked most dramatically — orders jumped by more than 200 percent, and annual spending more than quadrupled, from $4 million to $16 million.
* Use of anti-anxiety drugs and sedatives such as Valium and Ambien also rose substantially; orders increased 170 percent, while spending nearly tripled, from $6 million to about $17 million.
* Antiepileptic drugs, also known as anticonvulsants, were among the most commonly used psychiatric medications. Annual orders for these drugs increased about 70 percent, while spending more than doubled, from $16 million to $35 million.
* Antidepressants had a comparatively modest 40 percent gain in orders, but it was the only drug group to show an overall decrease in spending, from $49 million in 2001 to $41 million in 2009, a drop of 16 percent. The debut in recent years of cheaper generic versions of these drugs is likely responsible for driving down costs.
Antidepressants and anticonvulsants are the most common mental health medications prescribed to service members. Seventeen percent of the active-duty force, and as much as 6 percent of deployed troops, are on antidepressants, Brig. Gen. Loree Sutton, the Army’s highest-ranking psychiatrist, told Congress on Feb. 24.
In contrast, about 10 percent of all Americans take antidepressants, according to a 2009 Columbia University study.
Suicide risks

Many of the newest psychiatric drugs come with strong warnings about an increased risk for suicide, suicidal behavior and suicidal thoughts.
Doctors — and, more recently, lawmakers — are questioning whether the drugs could be responsible for the spike in military suicides during the past several years, an upward trend that roughly parallels the rise in psychiatric drug use.
From 2001 to 2009, the Army’s suicide rate increased more than 150 percent, from 9 per 100,000 soldiers to 23 per 100,000. The Marine Corps suicide rate is up about 50 percent, from 16.7 per 100,000 Marines in 2001 to 24 per 100,000 last year. Orders for psychiatric drugs in the analysis rose 76 percent over the same period.
“There is overwhelming evidence that the newer antidepressants commonly prescribed by the military can cause or worsen suicidality, aggression and other dangerous mental states,” said Dr. Peter Breggin, a psychiatrist who testified at the same Feb. 24 congressional hearing at which Sutton appeared.
Other side effects — increased irritability, aggressiveness and hostility — also could pose a risk.
“Imagine causing that in men and women who are heavily armed and under a great deal of stress,” Breggin said.
He cited dozens of clinical studies conducted by drug companies and submitted to federal regulators, including one among veterans that showed “completed suicide rates were approximately twice the base rate following antidepressant starts in VA clinical settings.”
But many military doctors say the risks are overstated and argue that the greater risk would be to fail to fully treat depressed troops.
For suicide, “depression is a big risk factor,” too, said Army Reserve Col. (Dr.) Thomas Hicklin, who teaches clinical psychiatry at the University of Southern California. “To withhold the medications can be a huge problem.”
Nevertheless, Hicklin said the risks demand strict oversight. “The access to weapons is a very big concern with someone who is feeling suicidal,” he said. “It has to be monitored very carefully because side effects can occur.”
Defense officials repeatedly have denied requests by Military Times for copies of autopsy reports that would show the prevalence of such drugs in suicide toxicology reports.
‘Then it’s over’

Spc. Mike Kern enlisted in 2006 and spent a year deployed in 2008 with the 4th Infantry Division as an armor crewman, running patrols out of southwest Baghdad.
Kern went to the mental health clinic suffering from nervousness, sleep problems and depression. He was given Paxil, an antidepressant that carries a warning label about increased risk for suicide.
A few days later, while patrolling the streets in the gunner’s turret of a Humvee, he said he began having serious thoughts of suicide for the first time in his life.
“I had three weapons: a pistol, my rifle and a machine gun,” Kern said. “I started to think, ‘I could just do this and then it’s over.’ That’s where my brain was: ‘I can just put this gun right here and pull the trigger and I’m done. All my problems will be gone.’”
Kern said the incident scared him, and he did not take any more drugs during that deployment. But since his return, he has been diagnosed with PTSD and currently takes a variety of psychotropic medications.
Other side effects cited by troops who used such drugs in the war zones include slowed reaction times, impaired motor skills, and attention and memory problems.
One 35-year-old Army sergeant first class said he was prescribed the anticonvulsant Topamax to prevent the onset of debilitating migraines. But the drug left him feeling mentally sluggish, and he stopped taking it.
“Some people call it ‘Stupamax’ because it makes you stupid,” said the sergeant, who asked not to be identified because he said using such medication carries a social stigma in the military.
Being slow — or even “stupid” — might not be a critical problem for some civilians. But it can be deadly for troops working with weapons or patrolling dangerous areas in a war zone, said Dr. John Newcomer, a psychiatry professor at Washington University in St. Louis and a former fellow at the American Psychiatric Association.
“A drug that is really effective and it makes you feel happy and calm and sleepy … might be a great medication for the general population,” Newcomer said, “but that might not make sense for an infantryman in a combat arena.
“If it turns out that people on a certain combo are getting shot twice as often, you would start to worry if they were as ‘heads up’ as they should have been,” Newcomer said. “There is so much on the line, you’d really like to have more specific military data to inform the prescribing.”
Military doctors say they take a service member’s mission into consideration before prescribing.
“Obviously, one would be concerned about what the person does,” said Col. C.J. Diebold, chief of the Department of Psychiatry at Tripler Army Medical Center in Hawaii. “If they have a desk job, that may factor in what medication you may be recommending for the patient [compared with] if they are out there and they have to be moving around and reacting fairly quickly.”
Off-label use

Little hard research has been done on such unique aspects of psychiatric drug usage in the military, particularly off-label usage.
A 2009 VA study found that 60 percent of veterans receiving antipsychotics were taking them for problems for which the drugs are not officially approved. For example, only two are approved for treating PTSD — Paxil and Zoloft, according to the Food and Drug Administration. But in actuality, doctors prescribe a range of drugs to treat PTSD symptoms.
To win FDA approval, drug makers must prove efficacy through rigorous and costly clinical trials. But approval determines only how a drug can be marketed; once a drug is approved for sale, doctors legally can prescribe it for any reason they feel appropriate.
Such off-label use comes with some risk, experts say.
“Patients may be exposed to drugs that have problematic side effects without deriving any benefit,” said Dr. Robert Rosenheck, a professor of psychiatry at Yale University who studied off-label drug use among veterans. “We just don’t know. There haven’t been very many studies.”
Some military psychiatrists are reluctant to prescribe off-label.
“It’s a slippery slope,” said Hicklin, the Army psychiatrist. “Medication can be overused. We need to use medication when indicated and we hope that we are all on the same page … with that.”
Combinations of drugs pose another risk. Doctors note that most drugs are tested as a single treatment, not as one ingredient in a mixture of medications.
“In the case of poly-drug use – the ‘cocktail’ — where you are combining an antidepressant, an anticonvulsant, an antipsychotic, and maybe a stimulant to keep this guy awake — that has never been tested,” Breggin said.
Newcomer agreed. “When we go to the literature and try to find support for these complex cocktails, we’re not going to find it,” he said. “As the number of medications goes up, the probability of adverse events like hospitalization or death goes up exponentially.”
Looking for answers

Pinpointing the reasons for broad shifts in the military’s drug use today is difficult. Each doctor prescribes medications for the patient’s individual needs.
Nevertheless, many doctors in and outside the military point to several variables — some unique to the military, some not.
A close look at the data shows that use of the antipsychotic and anticonvulsant drugs, also known as “mood stabilizers,” are growing much faster than antidepressants. That may correlate to the challenges that deployed troops face when they arrive back home and begin to readjust to civilian social norms and family life.
“The ultimate effect of both of these drugs is to take the heightened arousal — the hypervigilance and all the emotions that served you once you were deployed — and help to turn that back down,” said Dr. Frank Ochberg, former associate director for the National Institute of Mental Health and a psychiatry professor at Michigan State University who reviewed the Military Times analysis.
Dr. Harry Holloway, a retired Army colonel and a psychiatry professor at the Uniformed Services University of the Health Sciences in Bethesda, Md., said the increased use of these medications is simply another sign of deployment stress on the force.
“For a long time, the ops tempo has been completely unrelieved and unrestrained,” Holloway said. “When you have an increased ops tempo, and you have certain scheduling that will make it hard for everyone, you will produce a more symptomatic force. Most commanders understand that and they understand the tradeoffs.”
"Where is the intersection between the world's deep hunger and your deep gladness?"
What utter insanity!It's these doctors that should be prescribed anti-psychotics. :evil:
"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
Buckminster Fuller
April 26, 2010

US Army PTSD treatment: heaven and hell:

[Image: afghanistan.jpg]

BBC News and The New York Times have just each published articles on the US Army's treatment of psychologically traumatised soldiers so different that you'd think they were talking about entirely distinct programmes.
Two articles have just appeared on the BBC website giving a very positive view of the US military's treatment of Army veterans diagnosed with post-traumatic stress disorder (PTSD) and other mental health problems.
The articles largely focus on the programme at Fort Hood and despite some peculiarities (it mentions treatment includes acupuncture, reiki, sound therapy and seemingly chakra-based meditation) the picture is of a small but promising approach to treating psychologically disabled soldiers.
In contrast, The New York Times presents a damning picture of the treatment programme in which the service is poorly organised, where prescription and illicit drug abuse is rife and where clinicians rely largely on large doses of medication to manage soldiers' symptoms.
It's hard to know what to make of the articles, as the BBC seem to have made no effort to ask any difficult questions, while the NYT article seems to be largely based on interviews of soldiers who felt they were poorly dealt with, while the Army's own surveys discussed in the piece suggest most are happy with the services.
The stuff about New Age treatments is just a bit odd. Is this where the First Earth Battalion have got to these days?

Link 1 and Link 2 to BBC News articles.
Link to New York Times article.


Posted at April 26, 2010 08:00 AM
"Where is the intersection between the world's deep hunger and your deep gladness?"
There's no journalism involved in the BBC articles. The hack or hackette may as well have regurgitated mendacious press releases from Walter Reed and the Pentagon about how fantastically the US Army looks after its boys and girls.

Indeed, I note that there's no journalist credited with writing the pieces, so perhaps the articles were a simple cut-and-paste job from the DoD to the BBC.

I spent more than a decade trying to get documentary films about military PTSD commissioned by the BBC. The bosses were simply not interested in the subject.
"It means this War was never political at all, the politics was all theatre, all just to keep the people distracted...."
"Proverbs for Paranoids 4: You hide, They seek."
"They are in Love. Fuck the War."

Gravity's Rainbow, Thomas Pynchon

"Ccollanan Pachacamac ricuy auccacunac yahuarniy hichascancuta."
The last words of the last Inka, Tupac Amaru, led to the gallows by men of god & dogs of war
Pentagon Scientists Inject Necks to ‘Cure’ PTSD

by Katie Drummond

Finding an effective treatment for post-traumatic stress disorder has been a top Pentagon priority for years. And with an estimated one in five veterans from Iraq and Afghanistan suffering from PTSD, the military’s been willing to consider anything and everything, including yoga, dog therapy and acupuncture, to alleviate symptoms.
But a small new study out of Walter Reed Army Medical Center might offer more than temporary relief — with nothing more than a quick jab to the neck.
It’s a procedure called stellate ganglion block (STB), and involves injecting local anesthetic into a bundle of nerves located in the neck. The bundle are a locus for the sympathetic nervous system, which regulates the body’s “fight-or-flight” stress response.
Led by Lieutenant Colonel Sean Mulvaney, Pentagon scientists gave STB injections to two soldiers, one on active duty and another who’d been suffering from PTSD symptoms since serving in the Gulf War nearly two decades ago. Their study reports that both men “experienced immediate, significant and durable relief” after the 10-minute procedure, and no longer exhibit symptoms that would qualify them for a PTSD diagnosis.
Seven months later, both had successfully stopped using antidepressant and antipsychotic medications with the guidance of a psychiatrist.
While the research out of Walter Reed only tested two patients, a Chicago-based doctor named Eugene Lipov is already conducting his own double-blind trial on war-vet volunteers. One of his patients, 28-year-old John Sullivan, found little relief with prescription anti-anxiety meds. But the former Marine Corps Sergeant told ABC News that the STB injection completely eliminated his nightmares, flashbacks and ongoing anxiety.
“[It was] not painful and the results were within five minutes — I felt more relaxed and calmed down. It’s been great.”
Lipov has also conducted before-and-after brain scans on patients. Those suffering from PTSD usually exhibit characteristic “hot spots” that light up when a patient is exposed to violent imagery. After an STB treatment, the brains of PTSD patients no longer displayed the abnormal reactions.
But STB treatments, which have been used for decades to treat a handful of illnesses, including Raynaud’s Syndrome, aren’t without risks. Injuries to the nervous or vascular system are the most common, usually from a misplaced needle. Still, STB is likely to be met with more enthusiasm from the Pentagon than another potential PTSD treatment. MDMA, the key ingredient in ecstasy, was in the spotlight last week after successful results of a study on 21 veterans. But according to the Multidisciplinary Association for Psychedelic Studies, who sponsored the study, the Department of Veterans Affairs has thus far refused to collaborate on future research.
[Photo: Uniformed Services University]
"Where is the intersection between the world's deep hunger and your deep gladness?"
Sounds promising. But then I get depressed knowing that it is only a cheap fix so the Pentagon can get another 100,000 miles out of their machinery and they can go back into causing trauma for others.
"The philosophers have only interpreted the world, in various ways. The point, however, is to change it." Karl Marx

"He would, wouldn't he?" Mandy Rice-Davies. When asked in court whether she knew that Lord Astor had denied having sex with her.

“I think it would be a good idea” Ghandi, when asked about Western Civilisation.
Yeah,they want to do the same thing for my lower back pain.Inject a local anesthetic into my spinal nerves.I tell them NO WAY you doing that to me.It sounds to me like some quick fix to drop the patient from the PTSD roles,so that they don't have to compensate the Veteran.

MDMA might work ok,but you can't just keep guys loaded on it,WTF.How about something real simple,like let them smoke some reefer legally.We all use it anyways. :dontknow:
"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
Buckminster Fuller
Or not sending them to other people's countries to get (and cause) traumatised.
"The philosophers have only interpreted the world, in various ways. The point, however, is to change it." Karl Marx

"He would, wouldn't he?" Mandy Rice-Davies. When asked in court whether she knew that Lord Astor had denied having sex with her.

“I think it would be a good idea” Ghandi, when asked about Western Civilisation.
Multi-Symptom Pain Disorders Plague Returning Service Men And Women

Nine in 10 Iraq and Afghanistan veterans return with some form of pain and about 60 percent have significant pain, mainly from the cumulative effect of exposure to recurring blasts which cause unimaginable injuries, according to prominent VA pain clinicians speaking at the American Pain Society's annual scientific meeting.

"We are talking about a complicated set of problems involving cognitive issues, deep emotional impacts, and acute and chronic pain that have serious, long-term implications for our veterans and make effective pain treatment outcomes far more difficult to achieve," said Michael E. Clark, Ph.D., clinical director of the Veteran Administration's largest and most comprehensive pain management and rehabilitation program in Tampa, and associate professor, department of psychology, University of South Florida. "The pain constellation exhibited by returning service members is the most complex situation I have ever seen in my 30 years of practice and calls for a revolutionary new approach to simultaneously address the spectrum of shared, common symptoms across these severe disorders."

"These Middle East conflicts, with their very high level of blast injury survivors, call for the military, the VA and the civilian health system to treat post-injury pain as a priority after military discharge to prevent pathophysiology, with a focus of providing effective pain control and rapid restoration of function and social networks to prevent disability and secondary negative health and personal consequences of chronic pain," said Rollin M. Gallagher, M.D. MPH, deputy national program director for pain management for the VA and clinical professor of psychiatry and anesthesiology, Penn Pain Medicine, University of Pennsylvania

Dr. Clark added that the severity and breadth of the problem has been aggravated by the prevalence of multiple tours of duty for many service members, including weekend National Guardsmen who can be older with families and jobs, a situation not seen in previous U.S. conflicts.

Dr. Gallagher further noted the VA's pain care challenge is magnified by a 90 percent injury survivor rate from these conflicts compared with only 40 percent in the Vietnam War. VA clinicians are now challenged to manage pain in blast survivors with one or several other consequences of blast, such as head injuries causing mild to severe TBI, physical disfigurement and social stigma, emotional trauma, and often post traumatic stress disorder (PTSD).

"The evidence is compelling that the symptoms of these comorbidities, as well as others such as substance abuse, depression and sleep problems, overlap significantly," Dr. Clark explained, "and there is ample reason to believe they will not respond as favorably to traditional interdisciplinary pain treatment when compared to other groups of former soldiers."

"The need is for a fully integrated, system-wide and evidenced-based continuum of pain management from the battlefield to military hospitals to our community care facilities with increased pain care access, state-of-the art treatment protocols, high competence levels for care providers, and the integration of pain education into professional training," said Dr. Gallagher.

Dr. Gallagher pointed out that earlier and more aggressive acute pain treatment intervention closer to the battlefield may help to prevent or lessen longer-term disabilities and secondary consequences of chronic pain. "Present research will tell us definitely what we know from our clinical experience - that early blockage of neurological pain impulses to the spinal cord and brain close to the site of injury using peri-neural catheters and nerve blocks , along with more aggressive analgesic treatment, is proving more effective than the traditional method of just morphine injections," he said. "And the soldiers appreciate the earlier intervention."

VA's Integrated Pain Care Approach

The overlapping disorders of pain, mild traumatic brain injury (TBI), and post-traumatic stress (PTSD) among returning soldiers is leading to new initiatives at the VA.

"The VHA has directed a new pain management strategy with a stepped-care model that offers a comprehensive continuum of treatment from acute pain at injury to longitudinal management of chronic pain, and this approach is now being considered by the Department of Defense in collaboration with the VHA," Dr. Gallagher said. "The goal is to reduce pain and suffering and improve the quality of life for our returning Iraq and Afghanistan service men and women suffering acute and chronic pain."

"The use of silo treatment pathways in chronic pain treatment is insufficient, less effective and less efficient," Dr Clark said, "because they typically focus solely or primarily on pain-related symptoms and either exclude those with concurrent PTSD and/or TBI symptoms or occasionally refer them to relevant specialty programs for simultaneous but independent treatment."

As an example of the VA's health care system refocus, Dr. Clark reviewed current work at the Tampa VA facility using a single team approach and a post-deployment behavioral health program with specialties in behavioral medicine, pain, PTSD, TBI, substance abuse, physical therapy and case management.

"Our objectives are to maximize function and life adjustment, prevent symptom development or exacerbation, and reduce stress through a single team effort," Dr. Clark said. "Treatment involves established and modified cognitive behavioral therapy interventions targeting PTSD, pain, mild TBI, sleep and substance abuse, typically in combination, and with a physical training component.

"As we extend and refine our PMD treatment components and complete more research on PMC treatment and how overlapping comorbidities interact, our hope is that this raised awareness level for integrated care within the VA will eventually be reflected in community care center treatment for our returning service personnel," Dr. Clark summarized.

American Pain Society
"Where is the intersection between the world's deep hunger and your deep gladness?"
More accurately, hundreds of veterans were wrongly diagnosed with "personality disorders".

Quote:Hundreds of PTSD soldiers likely misdiagnosed

AP foreign, Sunday August 15 2010


Associated Press Writer= WASHINGTON (AP) — At the height of the Iraq war, the Army routinely fired hundreds of soldiers for having a personality disorder when they were more likely suffering from the traumatic stresses of war, discharge data suggests.

Under pressure from Congress and the public, the Army later acknowledged the problem and drastically cut the number of soldiers given the designation. But advocates for veterans say an unknown number of troops still unfairly bear the stigma of a personality disorder, making them ineligible for military health care and other benefits.

"We really have an obligation to go back and make sure troops weren't misdiagnosed," said Dr. Barbara Van Dahlen, a clinical psychologist whose nonprofit "Give an Hour" connects troops with volunteer mental health professionals.

The Army denies that any soldier was misdiagnosed before 2008, when it drastically cut the number of discharges due to personality disorders and diagnoses of post-traumatic stress disorders skyrocketed.

Unlike PTSD, which the Army regards as a treatable mental disability caused by the acute stresses of war, the military designation of a personality disorder can have devastating consequences for soldiers.

Defined as a "deeply ingrained maladaptive pattern of behavior," a personality disorder is considered a "pre-existing condition" that relieves the military of its duty to pay for the person's health care or combat-related disability pay.

According to figures provided by the Army, the service discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.

But after an article in The Nation magazine exposed the practice, the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn't the underlying cause.

After that, the annual number of personality disorder cases dropped by 75 percent. Only 260 soldiers were discharged on those grounds in 2009.

At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.

The Army attributes the sudden and sharp reduction in personality disorders to its policy change. Yet Army officials deny that soldiers were discharged unfairly, saying they reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006.

"We did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder," wrote Maria Tolleson, a spokeswoman at the U.S. Army Medical Command, which oversees the health care of soldiers, in an e-mail.

Command officials declined to be interviewed.

Advocates for veterans are skeptical of the Army's claim that it didn't make any mistakes. They say symptoms of PTSD — anger, irritability, anxiety and depression — can easily be confused for the Army's description of a personality disorder.

They also point out that during its review of past cases, the Army never interviewed soldiers or their families, who can often provide evidence of a shift in behavior that occurred after someone was sent into a war zone.

"There's no reason to believe personality discharges would go down so quickly" unless the Army had misdiagnosed hundreds of soldiers each year in the first place, said Bart Stichman, co-director of the National Veterans Legal Services Program.

Stichman's organization is working through a backlog of 130 individual cases of wounded service members who feel they were wrongly denied benefits.

Among those cases is Chuck Luther, who decided to rejoin the Army after the Sept. 11 attacks. He had previously served eight years before being honorably discharged.

"I knew what combat was going to take," he said.

Luther, who lives near Fort Hood, Texas, said throughout his time in the Army, he received eight mental health evaluations from the Army, each clearing him as "fit for duty."

Luther was seven months into his deployment as a reconnaissance scout in Iraq's violent Sunni Triangle in 2007 when he says a mortar shell slammed him to the ground. He later complained of stabbing eye pain and crippling migraines, but was told by a military doctor that he was faking his symptoms to avoid combat duty.

Luther says that he was confined for a month in a 6-by-8 foot room without treatment. At one point, Luther acknowledges, he snapped — biting a guard and spitting in the face of a military chaplain.

After that episode, Luther says, the Army told him he could return home and keep his benefits if he signed papers admitting he had a personality disorder. If he didn't sign, he said, he was told he would be kicked out eventually anyway.

Luther, whose account was first detailed by The Nation, signed the papers.

His case highlights the irony in many personality discharges. A person is screened mentally and physically before joining the military. But upon returning from combat, that same person is told he or she had a serious mental disorder that predated military service.

As in the civilian world, where many insurance companies deny coverage for illnesses that develop before a policy is issued, the government can deny a service member veteran health care benefits and combat-related disability pay for pre-existing ailments.

Despite the Defense Department's reforms, groups such as the National Veterans Legal Services Program say they don't have enough manpower to help all the veterans who believe they were wrongly denied benefits.

Stichman says his organization has more than 60 law firms across the country willing to take on the legal cases of wounded veterans for free. But even with that help, the group doesn't know when it would be able to take on even one new case.

A congressional inquiry is under way to determine whether the Army is relying on a different designation — referred to as an "adjustment disorder" — to dismiss soldiers.

Sen. Kit Bond, a Missouri Republican, wants the Pentagon to explain why the number of these discharges doubled between 2006 and 2009 and how many of those qualified to retain their benefits.

As for Luther, he got lucky. After about a year, he says the Veterans Administration agreed to reevaluate him and decided that he suffers from post-traumatic stress syndrome coupled by traumatic brain injury. The ruling gives him access to a psychologist and psychiatrist every two weeks, despite his discharge status, he said.

But Luther acknowledges that he still struggles. In June, he received word that the Army had turned down his appeal to correct his record, which means he could never return to the service or retire with full benefits.

A week later, he says, he lost his job delivering potato chips because a superior felt threatened by him. Luther says he misses the Army.

"When I was in uniform, that defined me," he said. "It's what made me, me."
"It means this War was never political at all, the politics was all theatre, all just to keep the people distracted...."
"Proverbs for Paranoids 4: You hide, They seek."
"They are in Love. Fuck the War."

Gravity's Rainbow, Thomas Pynchon

"Ccollanan Pachacamac ricuy auccacunac yahuarniy hichascancuta."
The last words of the last Inka, Tupac Amaru, led to the gallows by men of god & dogs of war

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