Thursday, January 28, 2010
The AALS Poster Project: Hillary Wandler's Culturally-Appropriate Assessment of PTSD in Native American Veterans
Hillary Wandler is the Legal Writing Fellow at The University of Montana School of Law. She teaches Legal Analysis and Legal Writing, and she taught the school's inaugural course offering on veterans' benefits law during the summer of 2009. Before teaching at Montana she clerked for judges on the United States District Court for the District of Montana and the Ninth Circuit and practiced at Garlington, Lohn & Robinson. She has published Will Montana Breathe Life into its Positive Constitutional Right to Equal Educational Opportunity, 65 Mont. L. Rev. (2004) and A New Way for Lawyers to Assist Veterans, 34-JUN Mont. Law 8 (2009).
Here was her poster proposal:
A veteran’s cultural background is relevant to and intertwined with the veteran’s PTSD symptomatology. Researchers at the National Center for Post-Traumatic Stress Disorder have discovered ethnocultural variations in the way veterans communicate symptoms of PTSD and other anxiety and depressive disorders in a clinical setting. See Anthony J. Marsella, Claude Chemtob & Roger Hamada, Ethnocultural Aspects of PTSD in Vietnam War Veterans, 1 NCP (Nat’l Ctr. for Post-Traumatic Stress Disorder), Fall 1990, at 3 (noting research showing “individuals from non-Western cultural traditions often fail to present classical symptoms of [anxiety and depressive disorders]” and, as a result, that “it is quite possible that ethnocultural minority veterans suffering from PTSD and related disorders may be wrongly diagnosed and inappropriately treated”). Researchers have long urged Compensation and Pension examiners in the VA to use culturally-sensitive clinical assessment procedures that fully explore potential cultural aspects of PTSD in a minority veteran. See id. (“Many questions used in clinical tests and interviews . . . are inappropriate in content for assessing ethnocultural minorities and thus do not accurately index problems that may be present.”); see also Terence M. Kean, Danny G. Kaloupek & Frank W. Weathers, Ethnocultural Considerations in the Assessment of PTSD, in ETHNOCULTURAL ASPECTS OF POSTTRAUMATIC STRESS DISORDER: ISSUES, RESEARCH, AND CLINICAL APPLICATIONS 183 (Anthony J. Marsella ed., Am. Psych. Assoc. 1st ed. 1996) (rejecting a single-instrument approach to diagnosing and assessing PTSD across different cultures). Published clinical assessments have demonstrated the kind of complex cultural issues that interact with PTSD and illustrated the kind of comprehensive assessment necessary to fully understand the multifaceted mental health issues of Native American Veterans suffering from PTSD. See, e.g., Jay H. Shore & Spero M. Manson, The American Indian Veteran and Posttraumatic Stress Disorder: A Telehealth Assessment and Formulation, 4 FOCUS 99 (2006). My research is exploring the extent to which the VA is actually implementing culturally-appropriate clinical assessment procedures to assess the severity of PTSD in Native American Veterans for purposes of service-connected disability compensation. Without system-wide implementation of culturally-appropriate assessment procedures, Native American Veterans are likely receiving inaccurate disability ratings, and thus inappropriate disability compensation.