Monday, 4 March 2013

7B. The PTSD Epidemic (Part 2 of 3)

The Problem of Diagnosis
         This, of course, brings us back to criterion A: a traumatic event. PTSD is unique in being defined, in part, by its cause. Theoretically, a patient can suffer all the other symptoms, but if there were no traumatic event, PTSD cannot be diagnosed. Indeed, this is not just theory; it happens all the time. As can be seen by the above example, psychiatrists are constantly making the diagnosis on the weakest of precipitant. There is no point is writing back to the doctor and saying: we don’t accept this diagnosis; tell us what is really wrong with him. The tame psychiatrist will stick to his guns. It might be useful obtaining a second opinion, but even then, the patient may stick to his guns about the symptoms he knows he has to have. When that happens, all psychiatrist no.2 can say is: it certainly looks like PTSD, but I don’t think he had a traumatic event.
The SoP for PTSD requires a “severe stressor”, which is defined in much the same manner as “traumatic event”. So does alcohol dependence or alcohol abuse, but the onset of the dependence/abuse must be within two years of the stressor. Anxiety state, on the other hand, used to requires a “severe psychosocial stressor”, also within two years. This was defined quite differently from a “severe stressor”, but many decision makers failed to make the distinction. The latest SoP, however, contains a whole string of diverse stressors and varied time frames, with the result that it is somewhat more generous and somewhat less generous than the previous one.
So let us examine closely the definition of “severe stressor”/“traumatic event”:
“The person experienced, witnessed, or was confronted with an event or events that involved actual or threat of death or serious injury, or a threat to the person’s, or another person’s, physical integrity.”
       The intention was to cover events well out of the normal range of experience, and which overwhelmed the victim’s coping responses. But immediately you should be able to see ways in which it can be watered down. Surely, we are all “confronted” with death whenever we attend a funeral? How far away do you have to be when you “witness” something? Does visiting an injured friend in hospital count? Just how immediate does a “threat” have to be? These days even an unattended bag can be a “threat”.
The RMA therefore decided to make an addition to the definition:
“In the setting of service in the Defence Forces, or other service where the Veterans’ Entitlement Act applies, events that qualify as stressors include:
(i) threat of serious injury or death; or
(ii) engagement with the enemy; or
(iii) witnessing casualties or participation in or observation of casualty clearance, atrocities or abusive violence.”
That should make it clear that the intention was to include only events that were really, really stressful – events involving close up encounters with death, danger, and destruction.
Or does it? Obviously, being required to clear out the emaciated bodies from a Nazi concentration camp would fit example (iii), but what about seeing a dead body by the side of the road? Some Tribunal members will accept that. And how severe does a “threat” have to be. Examples (ii) and (iii) clearly represent very severe situations, but veterans’ advocates will argue that (i) can mean, well, just about anything. Occasionally, they succeed.
Frequently, I have heard veterans state at a Tribunal hearing, “I didn’t know my problems were due to the war until I went to the R.S.L./Vietnam Veterans’ Federation etc, and had it explained to me.” As you might expect, such comments are never made by those who have been in the thick of the battle, whose days are haunted by memories of it, and who are afraid to go to sleep because of the nightmares. They always knew it was due to the war. What they needed to be told was that they needed help, and a pension. They never needed to nominate a stressor; it was with them all the time. The men who make those comments never got close to an enemy. But now that they are convinced the war is responsible, they wrack their memories for a stressor. If their claim fails the first time, they think back for a second stressor that might pass muster. There must be one, because they have been told it is all due to the war.

Weak Claims
Below are typical examples of the sort of “stressors” delegates of the Department of Veterans’ Affairs are faced with every day, in descending order of severity. Typically, the diagnosis is PTSD or alcoholism, and usually both. In every case, they were supported by a psychiatrist.
  • A man spent the night in a secure concrete bunker, listening to random rifle fire on the perimeter of the base, as VC and Australian infantry exchanged shots a hundred metres away.
  • A man was in what is assumed to be a secure area, when he saw an armed guerilla in the distance. No gunfire was exchanged; the enemy simply left, presumably knowing he was outnumbered.
  • An airforceman was working in a hangar when he heard a loud explosion. On racing outside, he saw that a mortar or rocket had fallen a couple of hundred metres away. Then he went back to work in the hangar.
  • A soldier went out in a vehicle for supplies, and found himself surrounded by a teenaged street gang. They appeared menacing, but were unarmed, and when he pointed his own rifle at them, they dispersed.
  • A man was driving in a convoy when they came to a bridge or culvert which had collapsed, apparently blown up, and they had to detour to the side. He was afraid of an ambush, but nothing happened.
  • A man went out on a patrol through the jungle, but never encountered the enemy.
  • A man was in camp when suddenly another soldier accidentally discharged his firearm, and everyone ducked for cover for a minute or two. (We get a lot of claims like that.)
  • A man was on sentry duty, when he heard a noise, and blasted away with his gun, only to discover it was a pig, or a bird.
  • A man was on sentry duty, afraid of what would happen if the enemy appeared, but nothing happened. (We get a lot of these claims, too.)
Perhaps the most persistent, and irritating claims are from members of the Vung Tau Ferry, that is, the naval vessels involved in the transport of troops and supplies to Vietnam, and their accompanying escort vessels. The voyage to and from Australia lasted a couple of weeks, and they were anchored off shore in Vung Tau Harbour for a day, or sometimes two. Originally, their service was not covered by the Veterans’ Entitlements Act, but once it was allotted, the claims started coming in.
I wouldn’t want to denigrate a class by the self-selected group that I encounter. The Vung Tau Ferry veterans are, I am sure, just ordinary sailors, embodying the full range of strengths and weaknesses, virtues and vices, of sailors everywhere. Regrettably, however, that means they have their quota of drunks. And every one of these alcoholics is claiming that his drinking stems from PTSD or anxiety, as a result of the terrifying events of his visit to Vung Tau.
Remember, these are men whose fathers’ generation held the line at Tobruk and Kokoda. Their grandfathers stormed the beaches at Gallipoli and the trenches of the Western Front. So just what did happen during the day or two in harbour which has left them mentally scarred for life? Basically, nothing. In the distance one could see American planes bombing the landscape. The ships were on high alert for possible enemy attacks which never came. In order to deter underwater saboteurs, “scare charges” consisting of a pound of explosives were thrown clear of the ship (in water, such an explosion can kill a diver), and sometimes one of these scare charges caught a crew member by surprise and made him jump.
Very few of these claims succeed, but enough slip through to encourage the others to apply. (You will no doubt not be surprised that most of them also claim to have started, or increased, their smoking habits on these brief voyages. Those claims are nearly always successful.)
On a par are claimants from the naval component of the Far Eastern Strategic Reserve (F.E.S.R.), who served in the latter half of the Malayan Emergency and in the Confrontation with Indonesia from 1957 to 1967. This service had also originally been excluded from coverage under the legislation, and for the same reasons: there had been no danger involved. Their experiences were somewhat more varied than those of the Vung Tau Ferry – they pursued and arrested unarmed Indonesian smugglers, occasionally blasted away at unseen targets on shore, and picked up soldiers who had been involved in real fighting, but at no time did they face anybody who could shoot back.
Particularly pathetic are those members of both groups who were victims of the Voyager disaster. When H.M.A.S. Melbourne collided with, and sank H.M.A.S. Voyager on 10 February 1964 with the loss of 82 lives, it left in its wake a host of severely traumatised survivors from both ships. The fact that it took twenty years for them to obtain compensation was a tragedy of the first order. Nevertheless, it was a peace time disaster, and not covered by veterans’ legislation. Rather, their compensation claims were decided under the worker’s compensation legislation effective at the time. But now, having received compensation (but not, as far as I can see, effective treatment), many of them are coming forward and attributing their PTSD and alcoholism to the very trifling events of their voyages to Vung Tau, or along the Bornean coast, and expecting us to ignore the Voyager elephant in the living room.
As one psychiatrist put it: “I think that once a diagnosis gets entangled in compensation and litigation issues, we clinicians and researchers should abandon it as a scientific entity. The populations described by it will be hopelessly contaminated by members sneaking in the door for financial purposes, or suitable members being left out because it would cost the public purse too much if the definition was such as they were left in.” [Straton, ibid]

Tame Psychiatrists
       By now you will have noted my references to “tame psychiatrists”. The starting point in understanding veterans’ mental problems is to realise that, although their veteran status makes them uniquely vulnerable to particular disorders, they are still ordinary human beings, and thus subject to the same range of psychiatric conditions afflicting the civilian population. Therefore, a point must be reached where even the most sympathetic psychiatrist will have to say: “This problem is not a result of the war, but of social and constitutional problems common in the rest of society.” However, there are certain psychiatrists who have never been known to reach this conclusion. If their patient is a veteran, they invariably attribute his problems to his service, no matter how bland it might have been. Nor is this blindness uncommon. There are whole sections of the country, especially in rural areas, where it is virtually impossible to find a psychiatrist who can be relied upon to be objective.
Tame psychiatrists also exhibit two other attributes. They exaggerate the severity of the veteran’s symptoms. If two psychiatrists rate the same patient under G.A.R.P., the tame psychiatrist will always give the (much) higher impairment rating. Secondly, their patients never seem to improve under their treatment.
A tame psychiatrist will say anything. Once I had to deal with the sad case of a World War II veteran who had committed suicide. He had taken part in the naval support of the invasion of Borneo, but it did not appear that he had been involved in actual fighting. Dr R took a history from his widow, who was claiming a War Widow’s pension, and made a posthumous diagnosis of longterm depression. This was almost certainly correct, and was corroborated by a more reliable psychiatrist. So far, so good. The widow’s main problem was that she did not meet him until after the war, and so was unable to provide any evidence of depression within two years of the war, as the SoP required (that, and the fact that he did not appear to have experienced anything to be depressed about). However, on the day of the Tribunal hearing, her lawyers came up with a number of letters she had just found – letters which he had apparently written to his parents at the time.
They were quite ordinary letters – the type you or I might write if we had been assigned a not-too-pleasant foreign posting. But as soon as she read them, the doctor announced that she had changed her diagnosis. She was now convinced he had had PTSD. I was flabbergasted. There was nothing contained in them remotely suggestive of a mental disorder, or even combat. Dr R was putting remarkable constructions on the most unremarkable statements. “I tend to walk the decks at night; it’s so noisy, I have difficulty sleeping.” Obviously, he is suffering from nightmares induced by the battle, nightmares he had never mentioned – either in the letter, or in the following fifty years when his wife was sleeping beside him. “Thank goodness I’ve now found a quiet place where I can sit down and write this letter.” Obviously, he is complaining of the intense reaction to noise, so common with PTSD.
Surely, doctor,” I asked her in cross-examination, “it’s perfectly normal for a person to look for somewhere quiet to write a letter? You wouldn’t want the TV to be blaring in the next room, for example.”
Oh, no!” she insisted, “a healthy person can write a letter under any circumstances.”
Incredibly, the Tribunal believed her.
Are any of these doctors dishonest? You be the judge.
Once Dr M (remember him) diagnosed PTSD, and was called to the Tribunal to justify his opinion. At that time, anxiety state was much easier to accept than PTSD, but most veterans and psychiatrists were too fixated on PTSD to know it. But the barrister knew it. Just prior to the hearing, he got on his mobile phone and asked Dr M if generalised anxiety disorder were not a more realistic diagnosis. An hour or two later, when he gave evidence, the doctor said he had changed his diagnosis to generalised anxiety disorder. Dr M also once told one of the Department’s doctors, categorically, that he considered his role was to get veterans their pension, and he would say whatever it took to do so.
Another time, a veteran based a claim of PTSD on an event on service which no amount of investigation could substantiate. At last, the canny bureaucrat called up his worker’s compensation records. Lo and behold! The event had actually taken place in Australia, at the workplace, and he had received compensation for it. But - would you believe? - the psychiatrist who wrote the report for the worker’s compensation claim was the same one who was now supporting his claim under the Veterans’ Entitlements Act.
Both of these, however, pale in comparison to Dr D. (My colleagues will all know whom I’m talking about.) Dr D undertakes occasional medico-legal work in worker’s compensation cases, but all his actual patients are veterans. Since, under the Veterans’ Entitlements Act, all veterans are entitled to free medical treatment for PTSD, anxiety, or depression, irrespective of whether or not it is service related, this means that almost the whole of his income derives from you and me, as taxpayers. But all of Dr D’s patients are suffering from war related trauma, no matter how uneventful that service may have appeared to a disinterested onlooker.
Not only that, but all of them are very severely psychiatricly disturbed. If they are not already incapable of working, even eight hours a week, they are nevertheless in imminent danger of losing their jobs. In applying G.A.R.P., Dr D has never been known to rate any veteran’s impairment at less than 40 points, which is close to the point where one tends to drop out of the workforce. It is not unknown for a veteran to be assessed by two other psychiatrists, and Dr D’s rating will always be 50 to 100% higher than the others.
Perhaps Dr D is an acknowledged specialist in veterans’ care? There are two ways this could be demonstrated. One is in publishing papers in the peer-reviewed literature on the treatment of PTSD. But all Dr D has ever published are a couple of articles on New Age type therapy. Another is when medical colleagues refer their difficult cases to him. But no fellow psychiatrist refers cases to Dr D. In fact, they regard him with contempt.
And, needless to say, Dr D’s patients never get better. When one of my fellow advocates raised the issue with him at the Tribunal, he said, in effect, “Well, the purpose of treatment is not so much to obtain an improvement, but to ensure that they do not regress even further.”
To this, I might quote what two more professionally motivated psychiatrists have told me:
  • If your patient fails to improve, you should (1) reconsider the treatment, (2) reconsider the diagnosis, or (3) seek a second opinion.”
  • Dr D always undermedicates his patients, and then steers them into his yoga classes.”
Dr D is the sort of person who ought to be blackballed by the Department of Veterans’ Affairs. He is a medical parasite battening off the taxpayers’ bounty, assisting undeserving characters to rip off the system, while ensuring that those genuinely traumatised victims unfortunate enough to fall his way are left to suffer under inadequate treatment. The only consolation is that his incompetence and dishonesty is so egregious that even veterans’ lawyers are starting to see through him. Some barristers will not give prospects unless another psychiatric opinion is obtained.
So why, you may ask, does the department use such psychiatrists? Well, they try to avoid them as much as possible. But, once an unfavourable report has been received, and the primary claim lost, there is nothing to stop a veteran from obtaining a second opinion from a tame psychiatrist for his VRB appeal. Often he will relate symptoms not mentioned to the original psychiatrist, and describe “stressors” never mentioned before. When pushed for an explanation, he will then say that he was unable to “open up” to Dr X, but Dr Y was so professional he was able to build up a rapport with him.
Added to this is the fact, mentioned before, that in some areas reliable psychiatrists are thin on the ground. Furthermore, many veterans’ organisations seek to pre-empt the department’s investigation by referring them direct to a tame psychiatrist of their own choice, and the department hierarchy, in a fit of generosity, promised the ex-service organisations that they would use the veteran’s treating psychiatrist, if he had one.
Now, although the provision of a medico-legal report by the treating psychiatrist is not exactly unethical, it is something their professional body tries to discourage, for obvious reasons. Objectivity is lost. A treating psychiatrist must empathize with his patient, must put himself in his shoes, and see things from his perspective. Besides that, the patient is providing his income, and psychiatrists are not immune to the psychological tendency to interpret the world according to their own self-interest. Also, it interferes with the doctor-patient relationship. Imagine what would happen if a psychiatrist told a patient, “I’m sorry, Mr Jones, but I can’t support your claim. Your problems were not caused by the war. Let’s withdraw the whole claim, and get back to trying to make you better.”
At one point in the pre-SoP days, the Government announced plans to set up specialist panels for the diagnosis of difficult cases. No mention was made of psychiatric disorders, but the ex-service organisations could see through it. They recognised it as an attempt to curtail the influence of tame psychiatrists. Although the ex-service organisations contain many members who have genuinely fought in battles, the idea that anybody should miss out on a piece of the cake merely because he had stood on the sideline, out of danger, was too much for them to bear. They raised such a fuss, that the plans were shelved.

A Culture of Weakness
        Such problems, of course, are not confined to veteran’s compensation. Claims for “workplace stress” have been open to so much abuse, that there have been moves by governments to wind back the scope of such entitlements. Then, in 1990, the press carried the tale of the toy penis.
Someone once introduced something similar into my own office: a small plastic phallus attached to a pair of legs, which allowed it to walk with a little clatter if the surface bore a slight slope. At the time, we considered it mildly amusing, if somewhat tacky, but in another office it had a more dramatic effect. When a woman brought one to work and placed it on her own desk, the man at the next desk complained to the sexual harassment officer. His wife, who worked a few metres away, also got into the act. The offending item was removed after a fortnight, but the damage had already been done. Husband and wife both had a case of the canniptions. He was off work for 19 months getting his sensitive psyche sorted out. Comcare agreed that he was entitled to worker’s compensation, and he received $45,000 in sickness benefits, along with $14,500 in rehabilitation expenses, including membership of a gym. Comcare also paid for his wife to attend a TAFE course in house decoration, and receive psychological counselling.
Sit down and ask yourself: how do people have the effrontery to make such claims? More importantly, how do they get away with it? What is it that makes otherwise sensible bureaucrats, judges, and psychiatrists lose all sense of proportion when dealing with contentions like this?
As a British psychiatrist once said: “Once it becomes advantageous to frame distress as a psychiatric condition people will chose to present themselves as medicalised victims rather than as feisty survivors.” [Derek Summerfield (2001): The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. Brit. Med. J. 322:95-98 , assessable here.] 
        To put it more bluntly, modern society encourages and rewards weakness.
In the old days, people were expected to be tough. As a matter of course, you were expected to put up with lousy bosses, overbearing workmates, and sullen customers, not to mention illnesses, loss of employment, and sundry other negativities. If your house burnt down, you lost a leg in a road accident, or some equally serious event took place, then you were supposed to commiserate with your friends, or talk it over with a minister, then pick yourself up, dust yourself off, and start all over again. You called yourself a battler, and took pride in the fact that you hadn’t let it get you down. Above all, you did not visit a psychiatrist, because that would mean you were “crazy”.
All this, I will agree, was rather tough on those people who really were traumatised or who, by reason of constitution or upbringing, had poor coping skills. But for the vast majority of people, it because a self-fulfilling prophesy, and allowed them to deal effectively with the normal trials of life, and often with the abnormal ones as well – such as the trenches of Gallipoli and France.
The first subtle change occurred after the Second World War, with the craze for trendy Americans to have a pet therapist to assist them in the everyday problems of life. Next came the new touchy-feely style of management, with an emphasis on a stressfree workplace. You can see the process at work with the issue of sexual harassment. Originally, it meant sexual extortion ie being forced to choose between one’s chastity and one’s job, but within a few years it became defined as a “hostile environment”, which essentially implied anything a member of the opposite sex does which you don’t like. Then the concept started to apply to all sort of hassles unrelated to sex. At the same time, counselling was introduced for any alarming or shocking experience out of the ordinary – even though recent studies suggest it may do more harm than good.
Perhaps the best example of the new outlook could be seen in the Star Trek franchise. The 1980s’ Next Generation starship actually included a full time counsellor among its crew of just a couple of hundred – something Captain Kirk’s tough old crew of the 1960s would have found incomprehensible.
A lot of positive things can be said for this new approach, but it sends an invidious message. If counselling is needed in the wake of any major fright or tragedy, then obviously you can’t be expected to deal with such matters on your own. If the workplace has to be stressfree, then it means you can’t possibly expect to be able to perform if your little feelings are hurt. And if you do happen to break down, it doesn’t mean you’re weak; if means you were right all along in claiming that people were victimising you – and you can expect someone to pay.
Many people also find it very easy to adopt the victim role. Back in the 1980s, I remember a pensioner coming out on TV and explaining that he was so poor he was forced to eat pet food. Of course, the very next day, members of various pensioners’ associations came forth and explained that he was on the same pension as everybody else, that pet food was more expensive than human food, and that there were many cheap methods of feeding oneself. But I doubt if he took any notice. It would mean taking responsibility for his own fate, and no longer blaming others.
To an extent, that last phenomenon can partly explain the attitude of many Vietnam veterans. Running like a red thread through their psychiatric reports is a well-articulated resentment of the way they were treated on their return. In earlier wars, the servicemen knew that the country was behind them. They didn’t have to put up with the jibes and insults of traitors. They didn’t have to read newspapers about the enemy’s flag being paraded boldly at political rallies addressed by Members of Parliament. On coming home, the troops from Vietnam were often whisked away under cover in order to avoid mobs of screaming, abusive fifth columnists. One veteran had an egg thrown at him by his own mother at a demonstration. Another was estranged from his sister for thirty years. Soon, they found that the people who had supported the enemy were now in power, and claiming the enemy’s victory as vindication. And the last people they wanted to deal with were the veterans themselves. Can anyone blame them for being resentful?
The society they came home to was also different to that faced by World War II veterans. The latter returned to a period of full employment; by the time the Vietnam War ended, Australia was in the grip of a recession. Veterans of the Second World War went back to rebuild their lives in a society where marriages were expected to last, and where the media, political parties, the churches, and the older generation reinforced a consistent consensus on moral standards. By the 1970s this consensus was being swept away by the general revolt against moral standards which had lost the war in the first place. When society abandons its rudder, those who have no rudder of their own must drift – and often run aground.
There is also another factor I hate to admit, but it is nevertheless the truth: my generation, the Baby Boomers, are not the men our fathers were – just as Generations X and Y are degenerate versions of us. Yes, I know this has been the wail of the older generation since Adam lost Abel, but in this case there are statistics to back it up. Every index of social disintegration who wish to name – be it divorce, illegitimacy, suicide, juvenile crime, adult crime, or drug abuse – has been increasing since the end of the Second World War.
In the course of my work, there were two additional trends noticeable among Vietnam veterans. Firstly, a few of them lodged claims for psychiatric conditions (usually self-labelled as “nerves” or “nervous condition” shortly after their return from service. Some of them were accepted, others, perhaps unfairly, were rejected. But in nearly every case, the condition was mild. It was only twenty or thirty years later, when the great PTSD epidemic was in full swing, that it became serious enough to interfere with their work. Secondly, half of those who went to Vietnam were national servicemen, including half of the front line soldiers (who, one professional soldier said to me, were some of the bravest men he had known.) However, perhaps because they failed to keep up the network of military ties, they were at least a decade behind the professionals in getting on the PTSD bandwagon. Certainly, before the mid-1990s, it was extremely rare to see such a claim from a national serviceman.
From all this, you may suspect that I have an animus against Vietnam veterans, and regard them as the “villains” of this chapters. On the contrary, it is merely to point out that, because of the generational difference, they present with problems different from those of earlier conflicts. Whether their claims are less genuine, or more numerous, than the others’, I am not prepared to judge. Certainly, a lot of them are genuinely traumatised and, of course, I don’t see all those who have never made a claim.
On the other hand, when I first joined the Department, the large number of World War II veterans with some sort of psychiatric disorder (usually labelled “anxiety state”) did attract my attention. In a straw poll, I found that a tenth of those turning 60 had such a condition accepted as war-caused, and another tenth had one rejected. (Whether these were correctly determined, I cannot say.) Its value as a source of income was not unknown in the veteran community. “I’ve been told it’s the best condition to have,” said one newly successful claimant, because its severity was purely subjective. In monetary terms, it could be worth as much as you wanted it to be.
When the PTSD epidemic commenced in the 1980s, veterans of the Second World War – and Korea, and Malaya as well – stepped forward with just as many claims as those from Vietnam. Many of them were genuinely traumatised old diggers who had only now been persuaded to claim what was owing them, but many others were highly questionable, yet hopelessly confused by the actions of uncritical tame psychiatrists, and by the veterans already knowing what they were expected to say. Exactly the same as Vietnam veterans, in other words.
Once the Second War generation had passed retirement age, and were no longer eligible for TPI, advocates from the RSL have taken it upon themselves to see that as many as possible get EDA. Omnibus claims for all the usual suspects – hearing loss, arthritis, solar skin damage, impotence – are submitted on their behalf, and “nervous condition” or “PTSD” is nearly always added to the list, if it has not already been accepted. Often enough, all that is wrong with the veteran is the general malaise of knowing that life is swiftly coming to an end, and he is left unfulfilled. In most cases, this is the first time a nervous condition has ever been broached, even with their GPs. Many of these old codgers front up to the psychiatrist without the slightest idea why they are there. If the claim fails the first time round, they will be sent on another round of appeals and psychiatric reviews, and eventually they really will be obsessed with everything that happened to them during the war.
Remember Mr B, originally mentioned at the start of the previous section? Towards the end of his life, some advocate decided he would be doing the courageous old gentleman a kindness by getting him to make a claim for PTSD. When he finally told his story to a psychiatrist, the latter couldn’t find anything wrong with him. That was too much for the advocate, who immediately got him to sign an appeal to the VRB, and referred him to a tame psychiatrist. Even he could find nothing wrong with him so, true to form, he reported that he must have PTSD, but he had hidden it too well. When the VRB rejected the appeal, his advocate immediately turned over the decision to a solicitor, with instructions to lodge an appeal to the AAT. This last action was taken without any consultation with Mr B, because if anyone had sought his opinion, they would have found out that he had just passed away.
Looked at objectively, surely this is a perfect example of what is wrong with the system of ex-service advocates and tame psychiatrists.

Continue to Part 3

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