December 29, 2005: Currently, some 215,000 veterans receive, on average about $20,000 each per year in disability payments for PTSD (Post-Traumatic Stress Disorder). Because PTSD is a mental condition, and difficult to diagnose with certainty (unlike, say, a missing limb or eye), such claims are subject to abuse. But PTSD is an emotional and political issue. It's also an economic issue. That's because, like Workman's Compensation and other types of disability benefits, a large number of consultants and lawyers have appeared, to help applicants press their case, whether there is a case or not. The amount of money paid out for PTSD claims has grown from $1.7 billion in 1999, to $4.3 billion this year. In addition to being an economic issue, PTSD is also a very emotional one.

PTSD, formerly known as Combat Fatigue, was first widely noted in the late 19th century, after the American Civil War. That war was one of the first to expose large numbers of troops to extended periods of combat stress, with long term effect on many soldiers. This was publicized after the war by the newly invented mass media (cheap newspapers made possible by highly efficient steam powered presses). The PTSD symptoms, as reported in the press over 150 years ago, have not changed. At the time, veterans were diagnosed as suffering from "Irritable Heart" (a popular description, back then, for stress related mental problems.) Symptoms noted included fatigue, shortness of palpitations, headache, excessive sweating, dizziness, disturbed sleep, fainting and flashbacks to traumatic combat situations. In World War I, the condition was called Shell Shock, and the symptoms were the same, although there was more attention paid to vets who jumped and got very nervous when they heard loud noises. During World War II and Korea, the condition was called Combat Stress Reaction. Same symptoms. During Vietnam, the term Post-Traumatic Stress Syndrome became popular, until it evolved into what we currently regard as PTSD. Actually, if you comb through military writings for the last few thousand years, you will note that PTSD has always existed. Too much combat "leaves a mark on a man" as the ancients were wont to note. But, the condition could always be faked or, more commonly, as many veterans preferred, hidden. Whatever the case, PTSD is real. The only problem is making sure that the real victims get available treatment, and that resources are not drained away by people who are faking it, for financial gain. This is not a new problem, Workman's Comp scams, often involving baseless claims for stress related injuries, caused many states to change their benefits regulations after the costs spiraled out of control.

Medical research is getting close to being able to diagnose PTSD with a great deal of certainty, whether the victim wants to admit to admit having it or not. For example, it's now possible, via a blood test, to determine who is most vulnerable to the psychological aftereffects of combat. This makes it possible to keep people out of combat units, who are likely to be most vulnerable to PTSD. This kind of screening, using cruder tools, has been done for a long time. You don't want people with you in combat, who are more prone to get quickly traumatized by it. Again, the old saying, "he doesn't have the nerves for it." In combat, someone having a mental breakdown can be dangerous for those around him. This is one of the reasons for stressful training. It both gets troops accustomed to working under stress, and also identifies those who can't handle. There are plenty of less stressful, and safer, jobs for these guys. Only about ten percent of the troops in the army have combat jobs, and even in a place like Iraq, only about a third of the troops are exposed to any kind of combat.