It’s the anniversary of Australia’s Royal Commission into Defence and Veteran Suicide. The report changed nothing on the ground. Today the men with clipboards deciding whether veterans are “making it up” are working from a diagnostic manual and a brain-chemistry theory that even the institutions who built them have since walked away from.
Note: The former NIMH director who backed the DSM left saying it lacks validity. The serotonin theory of depression never had the evidence behind it either. That’s what your DVA assessment currently rests on.
Today (9th September) is the anniversary of the release of the Royal Commission into Defence and Veteran Suicide final report (2024, Australia).
Has anything changed? Not from where I sit, and not from the perspectives of some of my online mates down in Vũng Tàu. Huge mea culpas from the Department of Veteran Affairs (DVA), ‘must do better’ from political parties, no needle moving as far as the actual veterans are concerned.
Sidebar: It’s worth noting that not ‘many’ Australian veterans live in Vũng Tàu in absolute terms—the community is relatively small—but it is noticeable because of its symbolic weight and the concentration of veterans who have chosen to make it their home decades later.
As a result of the very public, very real dressing down delivered by the report, the DVA hired a shit-load of staff to fix the backlog of claims (a good thing); the claims were registered in the system (finally, a good thing); the extra staff were then ‘let go’ when the job they were hired for was done; now we veterans wait in line for a small number of untrained civilians to assess via clipboard and tick box whether veterans are making it up about how they feel, or if their PTSD and other mental health challenges just ‘stopped’ when they left the service.
Many of us report feeling yet again let down by our government—promises, lies, obfuscations, and once more a strong feeling that ‘out of sight, out of mind’ means we may well die (by our hand or by our biology) before our claims get properly assessed by people competent and trained in mental health assessment.
The DVA’s own processes have made the assessments harder to access, including no longer funding follow-up psych assessments, and capping how much trained assessors can actually charge. The implication of which means that if the DVA decides one of us vets is ‘not worthy’ of help, or is ‘making it up’, we the veterans cannot get follow-up reports from qualified mental health experts—because the experts cannot now have their supplementary reports paid for by the DVA and therefore charge the veteran thousands of dollars up front.
And let me assure you that veterans do not, in the main, have thousands of dollars sitting in bank accounts immediately available to pay these expensive practitioners (justifiably expensive, they have spent many years—some close to a decade—to skill up and be qualified to assess and report, then years/decades actually working with veterans to better understand and support their mental health). The majority of veterans are driving Uber and food delivery vehicles to make ends meet. Not all, but many.
Some of the bleaker members of our community firmly believe that the DVA/Governments of the day are just letting the clock run out—on the strongly felt assumption that if we die before our claims are properly and fairly assessed, then the Government/DVA just saved itself a bit of money that can go back into General Revenue.
Bleak? Yes. True? Who can tell… certainly not the DVA and certainly not the Governments of the day. Well, they can—but they ain’t, for obvious reasons…
——
Oh, and add in the wrinkle that the assessment process is heavily reliant on the DSM, and its ‘category’ way of thinking was upended when major backers walked away from it. Thomas R. Insel from the NIMH, in particular, wrote a blogpost titled Transforming Diagnosis just before the APA triumphantly released the DSM-V; the agency that had thrown its weight and funding behind earlier editions would now be “re-orienting its research away from DSM categories”. His stated reason: “The weakness is its lack of validity.” Unlike ischaemic heart disease or lymphoma, he wrote, DSM diagnoses rest on a consensus about clusters of clinical symptoms rather than any objective laboratory measure. He also conceded that after eighteen months of trying to define categories for a new nosology, it became immediately clear a system could not be built on biomarkers or cognitive performance because the data did not exist.
Steven Hyman, Insel’s predecessor, by then at the Broad Institute, was making similar arguments from outside. And Insel himself left NIMH in 2015 for Google’s life sciences arm, later saying publicly that thirteen years and some twenty billion dollars of NIMH research had not moved the needle on suicide, hospitalisation or recovery—which is arguably the more damning reflection.
Yes, the clipboard and tick box Bic biro wielders rely heavily (if not solely) on a philosophical construct that has no evidential support. Much like the ‘brain chemical’ theory for individual mental health has zero actual evidential support—yes, the same theory that has driven mental health policy for decades, pushed out by the Septics into the rest of the world via their DSM and the pharmaceutical labs is, to quote a phrase of a friend of mine, ‘complete and utter bullshit’.
That’s not a vibe talking, that’s the scientific consensus based on evidence. There is no evidence for the claims either the DSM or the serotonin promoters make. None. Oops. Inconvenient.
Here’s Australia’s real national anthem, from the band that arguably wrote more anthems than Springsteen:
References
Insel, T. (2013, April 29). Transforming diagnosis. National Institute of Mental Health Director’s Blog.
https://web.archive.org/web/20180104205818/https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2022). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 28(8), 3243–3256. https://doi.org/10.1038/s41380-022-01661-0
(Epub 20 July 2022; formal issue August 2023—that’s why you may have seen it dated either year.)
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