iatrogenic

In his recent guest editorial, Richard McNally voices skepticism about the National Vietnam Veteran__ Readjustment Study (NVVRS) data reporting that over one-half of those who served in the Vietnam War have posttraumatic stress disorder (PTSD) or subclinical PTSD. Dr McNally is particularly skeptical because only 15% of soldiers served in combat units (1). He writes, __he mystery behind the discrepancy in numbers of those with the disease and of those in combat remains unsolved today_ (4, p 815). He talks about bizarre facts and implies many, if not most, cases of PTSD are malingered or iatrogenic. Dr McNally ignores the obvious reality that when people are deployed to a war zone, exposure to trauma is not limited to members of combat units (2,3). At the Operational Trauma and Stress Support Centre of the Canadian Forces in Ottawa, we have assessed over 100 Canadian soldiers, many of whom have never been in combat units, who have experienced a range of horrific traumas and threats in places like Rwanda, Somalia, Bosnia, and Afghanistan. We must inform Dr McNally that, in real world practice, even cooks and clerks are affected when faced with death, genocide, ethnic cleansing, bombs, landmines, snipers, and suicide bombers ...One theory suggests that there is a conscious decision on the part of some individuals to deny trauma and its impact. Another suggests that some individuals may use dissociation or repression to block from consciousness what is quite obvious to those who listen to real-life patients." Cameron, C., & Heber, A. (2006). Re: Troubles in Traumatology, and Debunking Myths about Trauma and Memory/Reply: Troubles in Traumatology and Debunking Myths about Trauma and Memory. Canadian journal of psychiatry, 51(6), 402.

In 2006, there is no army of recovered memory therapists, and Dr McNally__ assumptions about patients with PTSD and those working in this field are troubling. Owing to past debates, those working in the PTSD field are perhaps more knowledgeable than others about malingered, factitious, and iatrogenic variants.Why, then, does Dr McNally attack PTSD as a valid diagnosis, demean those working in the field, and suggest that sufferers are mostly malingered or iatrogenic, while giving little or no consideration is given to such variants of other psychiatric conditions? Perhaps the trauma field has been __o often embroiled in serious controversy_ (4, p 816) for the same reason Dr McNally and others have trouble imagining the traumatization of a Vietnam War cook or clerk. One theory suggests that there is a conscious decision on the part of some individuals to deny trauma and its impact. Another suggests that some individuals may use dissociation or repression to block from consciousness what is quite obvious to those who listen to real-life patients."Cameron, C., & Heber, A. (2006). Re: Troubles in Traumatology, and Debunking Myths about Trauma and Memory/Reply: Troubles in Traumatology and Debunking Myths about Trauma and Memory. Canadian journal of psychiatry, 51(6), 402.