The Trouble with Traumatology
SATEL, SALLY
The Trouble with Traumatology Is it advocacy or is it science? by Sally Satel Last month a series of letters appeared in Science. They were written in response to a study by trauma researchers at...
...But the tempest swirling around the NVVRS is a sorry episode in its own right, destructive to the conduct and culture of inquiry...
...Why assail only McNally when the Columbia analysis also resulted in a significant drop in estimated post-traumatic stress disorder...
...McNally's main contention was that the Columbia team used too lenient a definition of "impairment" in assigning a diagnosis of post-traumatic stress disorder to veterans...
...At last November's meeting he took the audience through the numbers...
...And elsewhere he had plainly acknowledged that certain support roles could put soldiers in harm's way...
...In fact, he said no such thing, as his published reply made clear...
...The McNally affair is a set piece in the sociology of science, a backdrop against which heated reaction to unpopular inquiry exposes the troubled state of an academic enterprise...
...The Columbia reanalysis found a more plausible estimate of post-traumatic stress disorder to be 9.1 percent...
...By recalibrating the definition of impairment, McNally found the prevalence of post-traumatic stress disorder to be 5.4 percent among men who served in Vietnam...
...That scandal ruined the lives of many patients and their families...
...She is a resident scholar at the American Enterprise Institute...
...it was the very reason Congress mandated the study...
...Curiously, too, none of the panelists directed any criticism toward the Columbia team...
...He believed the true estimate was even lower, more like 5 percent...
...All politely noted ambiguities in the data that may have led the Columbia team to reduce the post-traumatic stress disorder prevalence more than they believed was warranted, but none pressed the point...
...During the commentaries there were ripples of approving laughter from the audience...
...This is no secret of course...
...I want to thank Rich for his anecdotes," said the NVVRS coauthor in his introductory remarks, implying, of course, that while he himself did science, McNally merely told stories...
...But McNally struck a nerve because he was perceived as underplaying the traumatogenic nature of war and, by extension, the vast potential for psychopathology—and victim status—among returning troops...
...At a symposium called "Controversies Surrounding the Psychological Risks of Vietnam for U.S...
...They were written in response to a study by trauma researchers at Columbia University who examined the extent of long-term stress in Vietnam veterans...
...McNally applauded the rigor of the Columbia reanalysis but went a step further...
...The proportion of veterans afflicted was the sole policy-relevant aspect of the National Vietnam Veterans Readjustment Study...
...In fact, they praised its work lavishly...
...Sally Satel is a psychiatrist and coauthor, with Christina Hoff Sommers, of One Nation Under Therapy...
...It is a discipline in turmoil, torn apart by the passions of political advocacy on one side and the principles of scientific method on the other...
...Before getting to McNally's scientific presentation, a little background is in order...
...In short, it claimed that a "landmark" 1988 report—the National Vietnam Veterans Readjustment Study—had overstated the prevalence of residual post-traumatic stress disorder...
...This was remarkable because McNally's reworking of the data was the centerpiece of his presentation...
...Impairment must be present before a diagnosis of post-traumatic stress disorder can be made...
...After hearing McNally's presentation, three leading traumatologists, one of whom was a coauthor of the 1988 study, began their invited commentaries...
...Instead, they were aimed at Richard McNally, a professor of psychology at Harvard, who wrote the accompanying editorial...
...Known as the National Vietnam Veterans Readjustment Study (NVVRS), it put the prevalence of post-traumatic stress disorder at 15.2 percent of all men who had served in Vietnam...
...The raging controversy over repressed memories of child abuse—which reached a fever pitch in the mid-1980s and '90s—gave the field a self-inflicted black eye...
...The Columbia team, by comparison, expressed no particular doubts...
...How, they asked, could the prevalence be equal to the percentage of men assigned to combat, also 15 percent...
...The current tension over the National Vietnam Veterans Readjustment Study numbers, it is true, is far less sensational than "recovered memory therapy...
...This dynamic was on more colorful display just last November at the annual meeting of the International Society for Traumatic Stress Studies, the leading association of trauma specialists...
...But it was not the work of the Columbia team that the Science letters contested...
...The president of the International Society for Traumatic Stress Studies was one of the three commentators...
...This figure was for cases at the time the study was conducted, between 1986 and 1988—well more than a decade after the subjects had come home from the war...
...Because he was out of the country giving a long-planned lecture, McNally's talk was "presented" as a DVD of him giving a lecture on his reanalysis...
...Then they turned their guns on McNally...
...It shows, as McNally has put it, how vigorously "the advocacy tail can wag the scientific dog" in the world of trauma research...
...What I would like to do," he told the audience, "is to swear Rich and other critics in under oath to tell the truth, the whole truth, and nothing but the truth...
...The epistolary tension between McNally and his critics may seem like routine academic back-and-forth...
...His fault, in the critics' eyes, was to dismiss the possibility that non-infantry soldiers could have been exposed to wartime trauma...
...He virtually accused McNally of lying...
...Veterans: Multiple Perspectives on New Evidence," McNally walked the audience through his own analysis of the proportion of Vietnam veterans afflicted with post-traumatic stress disorder...
...This suggested, implausibly, that most infantrymen had developed cases of post-traumatic stress disorder that had lasted more than a decade...
...Ad hominem remarks aside, none of the panelists made a single mention of McNally's methodology...
...The letters represent a slice of a larger conflict within trau-matology...
...The three commentators—one was an adviser to the 1988 study—spoke of the "spin" McNally put on his "misleading" and "immoderate" presentation...
...One reason was that McNally was already in their cross-hairs for being a member of a vocal cadre of psychologists and historians of military psychiatry who insisted that the original estimate made by the NVVRS—namely, that 15 percent of troops had chronic post-traumatic stress disorder—was too high...
...I watched the DVD and listened to a recording of the symposium...
...As is usually the case with letters to the editor, some of the correspondence was critical...
...At least one person, however, found the atmosphere so unsettling that he asked aloud, "Is Rich McNally the Anti-Christ...
...The Columbia study that appeared in Science in August 2006 was a reanalysis of data from a 1988 study mandated by Congress to determine the degree of psychological stress among Vietnam veterans...
...The hostility towards a colleague and the complete failure to engage the novel and data-driven assertion he has made—indeed, the only truly new finding presented during the entire panel—reveal trau-matology to be a field in crisis...
...They issued impassioned pleas for "accurate" and "responsible" research, clearly implying that McNally's was neither...
...It undertook the reanalysis because trying to resolve the controversy impressed the researchers as a scientifically important matter, especially so, they believed, in light of a new generation of soldiers returning from combat in Iraq...
...When it was published last August, the Columbia article made headlines because it concluded that the psychological fallout from the Vietnam war was considerably less than previously thought...
...If that were done you would have seen an entirely different presentation, I think...
...But it goes deeper...
Vol. 12 • February 2007 • No. 22
