Needham, Mass.

Thank God someone has finally lifted the curtain on the appalling practice of tagging injured veterans with “personality disorder” to avoid giving them VA care. The unconscionable, revolting, self-serving weasel words from the military bureaucrats make one’s blood boil [Joshua Kors, “How Specialist Town Lost His Benefits,” April 9]. How do we get this to the larger stage? It needs to be exposed as a massive scandal. Any decent person would share my reaction: white-hot rage.

JOHN BONAVIA


Princeton, NJ

I was so sickened by Joshua Kors’s article that I had nightmares.

PETER HECKMAN


Ann Arbor, Mich.

How ironic that our soldiers are being cheated out of their military benefits and healthcare with the use of a specious diagnosis of personality disorder. Their Commander in Chief suffers from a classic case (DSM-IV-TR criteria for antisocial personality disorder: disregard for the rule of law, lying, impulsive behavior, hostility, financial irresponsibility, reckless disregard for safety and lack of remorse), but this doesn’t seem to disqualify him from anything.

REBECCA HATTON, PsyD


Brooklyn, NY

I’m thinking, since it’s obvious that our President suffers from personality disorder, and since (most of) the voters were not aware of this condition when he was elected, it would be appropriate to strip him of his job, his insurance and his benefits. He should also be required to use his elite family’s bank accounts to reimburse the country the billions he has stolen from it, including Specialist Town’s $15,000. A couple of years in a cage with a hood over his head listening to the Dixie Chicks turned up to 11 would be nice, too.

JIM McKAY


Kyoto

What personality disorders are these VA and Army doctors diagnosing? Each disorder has different diagnostic criteria. Borderline personality disorder? Paranoid personality disorder? Antisocial personality disorder? Narcissistic personality disorder? Schizotypal personality disorder? It is not possible for any reputable psychiatrist to diagnose a person with “personality disorder” as such.

MARK RICHARDSON


St. Paul

To blame a combat veteran’s posttraumatic stress symptoms on a pre-existing “personality disorder” is as logical as blaming the traumatic amputations of a veteran’s limbs on the pre-existing condition of being made of flesh that is susceptible to penetration by shrapnel and explosives.

ALFORD S. KARAYUSUF


Benton, Kans.

The idea that a traumatic event could release a “dormant” personality disorder, as apparently Colonel Knorr believes, is perhaps the most ignorant statement I have ever heard about such things in the thirty-plus years I have been in the mental health business. Just doesn’t happen, and by definition, can’t happen.

DOUGLAS E. MOULD, PhD


Boise, Idaho

Specialist Town did not lose his benefits. They were stolen from him. To validate a “pre-existing personality disorder” diagnosis, it would be necessary to go back and study the person before he or she entered the service. Sorry, but that is seldom done or even possible.

TOM EDGAR
Retired licensed psychologist


Providence, RI

As professors of psychiatry who have more than thirty years’ combined experience treating military veterans from all conflicts from World War I to Iraq and Afghanistan, we applaud your focus on posttraumatic stress disorder (PTSD) and its misdiagnoses. The article raises a harrowing subject–the misdiagnosis and dismissal from the military of psychiatrically wounded war veterans.

Joshua Kors reports that one military mental health clinician claims that “traumatic experiences can trigger a condition that has lain dormant for years” and thus produce a “personality disorder,” which is then grounds for dismissal from military service without disability benefits. There is no scientific evidence to support this statement–in fact, a personality disorder, by definition, cannot lie dormant for years. Rather, there are grounds to be concerned that PTSD will be at least as common in Iraq veterans as in Vietnam veterans. There are further grounds to be concerned that the diagnosis and clinical course of veterans with PTSD will frequently be complicated by closed head injury due to injury from improvised explosive devices. To misdiagnose such disorders as personality disorders is at best incompetent, and at worst scandalous.

The US military death toll and the number of wounded have been carefully documented and extensively reported. But in our society, mental disorders are stigmatized–ignored, minimized and brushed aside. Psychiatric casualties are the silent wounds of war, no less serious and no less chronic than its physical wounds. Kors’s article makes this abundantly clear, and makes clear as well the stigma that haunts even men and women who have suffered indescribably dangerous conditions.

MARK S. BAUER, MD
M. TRACIE SHEA, PhD


Ogunquit, Me.; York, Me.

As mental health professionals we were particularly disturbed by evidence that strongly suggests diagnoses made for military convenience and not in the best interest of the patient. We would like to suggest a type of intervention. Complaints can be filed against the practitioners in question with the licensing boards and professional organizations to which they belong. The filing of such complaints is usually not difficult and typically is without expense. Mental health professionals who engage in unethical practice, including malpractice, are not immune from complaints filed this way.

The benefits of filing a successful complaint would be significant. Not only would it provide a sense of satisfaction and vindication for the GI, it would send a message to military health professionals that they are still bound by ethical practice guidelines. In addition, disciplinary measures, which could include loss of license, would follow these practitioners into civilian practice. Thus a strong and chilling message could lead to a return to professional practice, not “military convenience practice.” This would be a more productive way to “support the troops.”

HERBERT J. HOFFMAN, PhD
HENRY GUERTIN-OUELETTE, PhD
EUGENE GLICK, MD


Sedona, Ariz.

I’m a brown shoe Army vet and I’m ashamed, angry and damn angry. The way I see it, those folks made a promise to risk their lives for us, and in return we promised to take care of them if they got hurt. Well, they didn’t break their promise. But we did.

BYRON McKEOWN


Crystal Lake, Ill.

I am a veteran, my brother is a veteran and my son is a veteran, and I am outraged. The good news is that a veterans’ advocate, such as a Disabled American Veteran Representative, can file that veteran’s claim and beat that designation. Unfortunately the re-enlistment code and reason for discharge cannot be removed except by a board of that branch of service. This requires a petition, then a long wait with few positive results. If you think that’s infuriating, I have seen the personality disorder designation given to female rape victims so they will be discouraged from filing for VA benefits or pursuing their claims in civil court.

KAREN T. METER


Dover, Dela.

This article is so incredibly upsetting, I fear I can’t adequately express my anger and shame about it. My husband was in the Army for more than twenty-six years (and we loved Army life). But there’s an old saying that is all too true, then and now: “Nothing is too good for our brave men and women in uniform, and that’s exactly what we’re going to give them. Nothing.” Where’s the outrage? Are the parents and spouses of these soldiers being scared into silence? Where’s Congress in all this? Most important, where can I sign up to protest this disgraceful treatment?

MARY EMANUELSON


Eugene, Ore.

So the screwing goes on. My father was an atomic veteran, sent in twenty-four hours after the bomb blast in Bikini. I had to help him fight to get information on atomic veterans’ benefits. I was stationed in Thailand during Vietnam in the bomb dump. Picture this area with absolutely no vegetation in the middle of the jungle. When I got out I started hearing about Agent Orange and went to the VA to be put on the Agent Orange registry. They wanted to deny me, saying they had no records of herbicides used in Thailand. Well, I pitched a big fit and finally got on the registry. Just last year the Defense Department admitted to the use of herbicides, not only in Thailand but in the States also. So you see, the military just wants your body. The higher-ups continue to be bought off with overgenerous salaries and benefits. I am sorry for the Iraq veterans and what they are going through. One more reason to get rid of Bush and his band of thugs.

DIRK BEAULIEU


Eden, Ga.

My father is 85 and a World War II veteran. He received the same treatment. His wounds were called “pre-existing conditions,” and he was told he’d get only 10 percent disability, but he never received it, and he gave up trying. A few years ago he joined a veterans’ group that showed him how to get his benefits from long ago. He eventually received 100 percent disability, was reimbursed what was due, paid off all his bills and continues to receive it.

TERI LOWERY


Brunswick, Me.

As a 2nd Marine Division psychiatrist during the latter years of Vietnam, I facilitated “General Discharge Under Honorable Conditions” for a number of marines. I tried to do right by each one, but I later learned that accepting the General Discharge was not in the best interest of many. The role of the psychological professional in the General Discharge invites a benign collusion with the suffering soldier and his/her command. The moment the soldier enters the professional’s office, the “facts” seem to organize themselves to encourage expedient discharge. Negative representation is always possible, because when we surface the murky details of our lives, none of us look very good on paper.

However, the behavior of the professionals involved with Specialist Town and others goes way beyond benign collusion into the realm of serious corruption. These professionals are violating their deepest ethical principles by overlooking psychiatric symptoms and thereby failing to treat in the military setting while simultaneously blocking access to treatment in civilian life. These professionals are doing incalculable damage to soldier/citizens who had hoped to serve their country honorably. Full investigation is imperative.

WALTER R. CHRISTIE, MD


KORS REPLIES

New York City

My inbox was flooded after The Nation ran my article on Spc. Jon Town, wounded by a rocket in Ramadi, Iraq, then diagnosed and discharged with “personality disorder.” Readers told me about spouses and friends who were discharged under similar circumstances. Doctors wrote me aghast at the clear-cut nature of the military’s misdiagnoses.

Meanwhile the personality disorder stories kept rolling in. I’m now investigating the case of one soldier who damaged the lens of his eyeball in Iraq, damage his doctor said was caused by a pre-existing personality disorder.

Most readers asked how they could help. I advised them to forward the article to family and friends, to their Congressional representatives and to Representative Bob Filner, chairman of the House Committee on Veterans’ Affairs. Having worked on this story for seven months now, it’s clear to me that the scandal won’t be resolved until the wounded soldiers get a chance to tell their stories in open hearings, on camera, directly to the American people.

Some readers decided not to wait. They have been reaching out to Specialist Town directly:

“The continuous phone calls and e-mails that I get from random people–it’s amazing to see how many people care,” Town says. “You’ll be having one of those days where you just want to crawl back in bed. Then someone calls and says, ‘Hey, I read the article. What can I do for you?’ It really does brighten your day.”

Congressional action to address the personality disorder scandal is beginning–slowly. I’ll have details on those developments and developments in Specialist Town’s case in an upcoming Nation article.

JOSHUA KORS