from Iraq Now. The most clinically useful biological finding in PTSD is that, in contrast to Major Depression, (the 'stress hormone') cortisol levels are low. Aerni at al. in the American Journal of Psychiatry summer 2004 discuss how low cortisol lends to consolidation of traumatic memories and that 10 mg a day of Cortef for a month may be helpful in halting this. Sometimes, especial early in the course of disease if it is to have a quick effect, lithium has been dramatic in its effect. Lithium use is not in current algorithms though, was first reported on by Bessel van der Kolk in 1983. For diagnosis, using the CAPS, the "clinician ..PTSD scale," in an appropriate way drops you past the patients irritabiity defenses, an aspect of PTSD = personality disorder diagnostically. PTSD is like panic in that if there is suspicion and you deny it you may be more likely to have it.
I like reductio ad absurdum arguments. In such an argument you take a hypothesis and draw it's logically consequences to something absurd, or known to be false, thus disproving the original hypothesis. Something of an example can be made here of the argument that PTSD is a false construct. You may see below in my description of the uses of trauma By general Giap in his war strategy against the US that a soldier involved in hand to hand combat, eventually surviving by stabbing the north Vietnamese in the belly while holding the man's rifle, getting blood all over his hands in the man's death. 20 years later, the sargeant spends years trying to wash the blood off his hands by rubbing them as in Shakespeare's Macbeth. I submit that it is logical that in the pregunpowder days, war would have much more often involved combat with hand held piercing instruments and late intrusive memories of the combat would have involved such incidents. By incorporating such a psychic struggle, memory in a scene in Macbeth, Shakespeare shows that he knew of such in the human condition. He also associated it with a sense of guilt, one potential diagnostic criteria in the PTSD diagnosis. Allow me to say that it is absurd to think that Shakespeare included such a report based on the litigiousness and pseudoscience of American law or payments by VA.
A cautionary note too about 'Stolen Valor.' One of my patients spent a tour as a liaison office for the Air Force but with the Army in Laos. We didn't have a big contingent there. By treaty negotiated by Harriman for JFK, that the north said later convinced them we weren't serious about South VN, neither we nor the north were in Laos, not that that affected there presence there a whit. People next to him in small planes were shot on take-off. When he came back to (?) Arizona to get his next assignment, the clerk there started off by saying, "Well I see you haven't had a foreign assignment in a while..." I haven't read it though.
Something I have read that I note more than others is that the professor disputing the relevance or incidence of PTSD if from the University of South Carolina Medical School. It has a history of nihilism with regards to PTSD. I quoted a paper from there in my publication in Military Medicine in 1991, p 100-101.
I thought there nihilistic view of our medication strategies in PTSD was appropriate. Recently this institution had several articles published in the British Journal of Psychiatry supporting the quote in Dr. Helen. The editor of the journal opined that PTSD was maybe not a real diagnosis like schizophrenia or Major Depression. Part of the discussion was about having the diagnosis and not having been in the war theater. I sent in a case report supporting this possibility. This was turned down as I am sure they turn down a lot of prospective articles. Lisa Oliver, delightful lady and English name, who deals with these things conveyed to me 'that the readership wouldn't have sufficient interest.' The politics of PTSD does not just involve it's advocates.