Letters to the Editor
Re: Troubles in Traumatology, and Debunking Myths About Trauma and Memory
Dear Editor:
In his recent guest editorial, Richard McNally voices skepticism about the National Vietnam Veteran’s 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, “the 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.
Regardless of whether one accepts the concept of traumatic amnesia, Dr McNally is correct—memory does not operate like a video tape, emotionality does not confirm veracity, and implicit memory cannot simply be translated into narrative memory (4). We agree there are significant risks with active memory enhancement techniques (for example, amobarbital or hypnosis). These techniques have not been advocated for years. A recent PubMed and PsychAbstracts search bears this out, as we could not find a single reference for recovered memory therapy apart from those writing about its dangers. Our experience suggests that an overwhelming majority of clinicians do not assume or suggest to clients that they must have buried traumas from their past. It is also our experience that most clinicians are careful not to assume the literal veracity of reported traumatic memories, whether newly remembered or not.
In 2006, there is no army of recovered memory therapists, and Dr McNally’s 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 “so 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.
References
1. McNally RJ. Troubles in traumatology. Can J Psychiatry 2005;50:815–6.
2. King DW, King LA, Foy DW, Keane TM, Fairbank JA. Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables. J Abnorm Psychol 1999;108:164–70.
3. Litz BT. The psychological demands of peacekeeping for military personnel. NCP Clinical Quarterly 1996;6:3–8.
4. McNally RJ. Debunking myths about trauma and memory. Can J Psychiatry 2005;50:817–22.
Colin Cameron, MD,
Alexandra Heber, MD
Ottawa, Ontario
|
