Friday, August 10, 2007

Susan Blumenthal, M.D.: A Pervasive Wound of War -- Post-Traumatic Stress Disorder. By: Susan J. Blumenthal, M.D. and Elise Schlissel* Two weeks ago, the President's Commission on Care for America's Returning Wounded Warriors issued its report to address the glaring inadequacies of the military medical and benefit system first revealed five months ago. The document details dozens of important recommendations and steps for action. However, significant problems still remain for the treatment of an often forgotten, yet pervasive wound of war -- mental disorders. The psychological health of America's military service members and their families poses a daunting challenge for the military community and our society. Of the veterans from Afghanistan and Iraq treated at government facilities as of November 2006, one-third were diagnosed with a mental illness. In particular, there is a pressing need to respond to the alarming prevalence of a complex illness that afflicts over 34,000 Iraq and Afghanistan veterans -- Post-Traumatic Stress Disorder (PTSD). PTSD is an anxiety disorder that develops in individuals who have experienced a traumatic event. The condition is typically characterized by a range of symptoms, including flashbacks, emotional numbness, depression, memory problems, and hyper-arousal. PTSD is a serious mental illness that without early identification and effective treatment has the potential to be chronic, debilitating, and even lethal, with high rates of suicide. The diagnosis of PTSD was first coined to describe this set of symptoms in 1980, but it is a young disease in name only. War veterans have experienced this disorder (often termed "shell-shock" or "war neurosis") throughout history, and the wars of the 21st century are reminding the world why. According to a 2004 study cited by the National Center for Post Traumatic Stress Disorder, 94 percent of soldiers in Iraq are the victims of what is termed "small-arms fire"; 86 percent knew someone who was seriously injured or killed; and 51 percent had handled or uncovered human remains. These traumatic experiences combined with long or repeated deployments in a politically controversial war make servicemen and women in Iraq particularly vulnerable to PTSD. In fact, 12 to 20 percent of returning soldiers experience PTSD compared to about 5 percent in the general population. The problem becomes even more complex in the context of women serving in the military. In their combat roles, service women in Iraq are subject to both violence from the war and assault from fellow service members or superiors. According to a 2003 study, approximately one-third of female veterans visiting the V.A. for health care reported having been subject to rape or attempted rape during their military service. The combination of sexual assault with the psychological trauma from combat known to contribute to PTSD in military personnel has created an environment in which an estimated 20 percent of servicewomen will develop this condition -- that's four times the rate in the civilian population and more than double the rate of PTSD in male soldiers (~8 percent). Yet despite these alarmingly high rates of PTSD, the unique needs of servicewomen have not been adequately addressed. This lack of attention is significant and disturbing given the recognition over the past decade of the inequities in women's health research and care and the importance of focusing on sex differences. Finally, one of the most troubling effects of military-related PTSD is its chronic course. Studies have shown that with effective treatment and the passage of time, between 40 and 60 percent of those suffering from PTSD will recover. However, due to the nature of the disease about one in three patients will continue to experience some symptoms throughout their lives. Once veterans manifest chronic problems, their condition becomes more difficult and resistant to treatment, underscoring why it is vital to provide early intervention. The Commission's report addressed the pressing need to streamline veterans' care. In implementation efforts to simplify access to services, it is critical that mental health needs of veterans are made a top priority. The report highlights the lack of mental health professionals to serve military personnel and their families, so it is essential that both the DOD and the V.A. act quickly to rectify this deficiency. As of March of this year, only 27 of the 1,400 Veterans Administration hospitals and clinics contained inpatient PTSD centers and only two served women exclusively. The combination of a lack of government facilities and mental health professionals trained to detect and treat PTSD underscores the urgent need to create a public-private partnership to provide our veterans with state-of-the-art care in their own communities, where the support of family and friends will be critical components of recovery. Congress is providing funding to advance veterans' health care, but much more needs to be done and vigilance is required to ensure that the Commission's recommendations are effective in healing the emotional wounds of war. But the fact of the matter is, what America really needs is a fundamental alteration in the way in which mental illness is viewed in today's society. Nearly one out of every four American adults will suffer from a mental illness annually, yet only a fraction of them will be accurately diagnosed and effectively treated. In the upcoming 2008 U.S. presidential election, the candidates have an historic opportunity to address mental health concerns. It's time for America to step up -- for the health of her veterans and her public -- and shatter the stigma that has surrounded mental illness for all too long by providing parity in the diagnosis and treatment of these real, disabling disorders. *Rear Admiral Susan J. Blumenthal, M.D (ret.) served as Assistant Surgeon General of the United States and the first Deputy Assistant Secretary for Women's Health in the U.S. Department of Health and Human Services. She is a Clinical Professor of Psychiatry at Georgetown and Tufts University Schools of Medicine and Distinguished Advisor for Health and Medicine at the Center for the Study of the Presidency (CSP) in Washington D.C. Elise Schlissel, a junior at Princeton University in the Woodrow Wilson School of Public and International Affairs, is a health policy intern at CSP. [The Huffington Post Full Blog Feed] 12:36:39 PM    comment []

Marjorie Cohn: FISA Revised: A Blank Check for Domestic Spying. Responding to fear-mongering by the Bush administration, the Democrat-led Congress put its stamp of approval on the unconstitutional wiretapping of Americans. George W. Bush has perfected the art of ramming ill-considered legislation through Congress by hyping emergencies that don't exist. He did it with the USA Patriot Act, the authorization for the Iraq war, the Military Commissions Act, and now the "Protect America Act of 2007" which amends the Foreign Intelligence Surveillance Act (FISA). FISA was enacted in 1978 in reaction to excesses of Richard Nixon and the FBI, who covertly spied on critics of administration policies. FISA set up a conservative system with judges who meet in secret and issue nearly every wiretapping order the administration requests. But that wasn't good enough for Bush. In 2001, he secretly established his "Terrorist Surveillance Program," with which the National Security Agency has illegally spied on Americans. Instead of holding hearings and holding the executive accountable for his law-breaking, Congress capitulated once again to the White House's strong-arm tactics. As Congress was about to adjourn for its summer recess, Bush officials threatened to label anyone who opposed their new legislation as soft on terror. True to form, Congress - including 16 Senate and 41 House Democrats - caved. The new law takes the power to authorize electronic surveillance out of the hands of a judge and places it in the hands of the attorney general (AG) and the director of national intelligence (DNI). FISA had required the government to convince a judge there was probable cause to believe the target of the surveillance was a foreign power or the agent of a foreign power. The law didn't apply to wiretaps of foreign nationals abroad. Its restrictions were triggered only when the surveillance targeted a U.S. citizen or permanent resident or when the surveillance was obtained from a wiretap physically located in the United States. The attorney general was required to certify that the communications to be monitored would be exclusively between foreign powers and there was no substantial likelihood a U.S. person would be overheard. Under the new law, the attorney general and the director of national intelligence can authorize "surveillance directed at a person reasonably believed to be located outside of the United States." The surveillance could take place inside the U.S., and there is no requirement of any connection with al-Qaeda, terrorism or criminal behavior. The requirement that the AG certify there is no substantial likelihood a U.S. person will be overheard has been eliminated. By its terms, the new law will sunset in 180 days. But this is a specious limitation. The AG and DNI can authorize surveillance for up to one year. So just before the statute is set to expire around February 1, 2008, they could approve surveillance that will last until after Bush leaves office. There is provision for judicial review of the procedures the AG and DNI establish to make sure they are reasonably designed to ensure communications of U.S. persons are not overheard. But that requirement is also specious. They must submit their procedures to the Foreign Intelligence Surveillance Court 120 days after the effective date of the act. The court doesn't have to respond to their submission until 180 days after the effective date of the act, and the standard of review is appallingly low. It's limited to whether the government's determination is "clearly erroneous." Even if the court were to find the proffer clearly erroneous, the AG and DNI have another 30 days to fix it. That takes the entire review process beyond the 6 month sunset period. Meanwhile, the surveillance can continue. The Supreme Court held in the 1967 case of Katz v. United States that government wiretapping must be supported by a search warrant based on probable cause and issued by a judge. In 1972, the Court, in U.S. v. U.S. District Court (Keith), struck down warrantless domestic surveillance. The Court has recognized the "special needs" exception to the warrant requirement. The special need must be narrowly tailored to the problem. However, the new law is much too broad to come under this exception. Congress eliminated any need that the person surveilled be a foreign power or an agent of a foreign power. The government need only show it is seeking "foreign intelligence information." There is no requirement of any connection with terrorism. The special needs exception also requires an absence of discretion in the implementing authority. There is unlimited discretion now as long as the target is reasonably believed to be outside the United States. The AG is required under the new law to report to Congress semi-annually, but only on incidents of non-compliance. Can we really trust Alberto Gonzales to be forthcoming about compliance with this law? Senator Christopher Dodd told Glenn Greenwald at the YearlyKos convention last week that neither he nor the other senators have any idea of how the Bush administration has been using its secret program to spy on Americans. Finally, the new law requires telephone companies to collect data and turn it over to the federal government. It also grants immunity against lawsuits to these companies, many of which are currently defendants in civil cases. Indeed, the mad rush to push this legislation through last week was likely a preemptive strike by Bush to head off adverse rulings in lawsuits challenging the legality of his Terrorist Surveillance Program. On August 9, a federal district court in San Francisco will hear oral arguments by lawyers from the Center for Constitutional Rights and the National Lawyers Guild in CCR v. Bush. And on August 15, Guild lawyers and others will argue Al-Haramain v. Bush in the 9th U.S. Circuit Court of Appeals. In six months, when the "Protect America Act of 2007" is set to expire, there will be even more political pressure on Congress to appear tough on terror in the run-up to the 2008 presidential election. We cannot expect a Congress that so easily caved in to the fears hyped by the Bush administration to stand firm in support of the Constitution. Marjorie Cohn is a professor at Thomas Jefferson School of Law and President of the National Lawyers Guild. Her new book, Cowboy Republic: Six Ways the Bush Gang Has Defied the Law, has just been published by PoliPointPress. Her articles are archived here. [The Huffington Post Full Blog Feed] 7:43:02 AM    comment []

© Copyright 2007 Patricia Thurston.