mccainbrain.jpgSenator McCain isn’t the only Beltway regular with memory lapses. Yesterday the WaPo showed the same problem in writing about his apparent psychiatric symptoms. Something in D.C.’s water — or is there something in the rarified air the Villagers share?

The WaPo article assured readers that John McCain’s years of imprisonment as a POW during the Vietnam War had not left him with"POW aftereffects."

Of course, I hope that no one has "POW aftereffects." As a physician and psychiatrist with a fellowship in trauma psychiatry I also know that people subjected to torture during confinement — whether in Hanoi or Gitmo — are at greater than average risk of PTSD symptoms from what they have endured.

I also know that the Washington Post and other media outlets have described Senator McCain displaying behaviors that appear to satisfy two of three criteria for the responses to trauma required to diagnose PTSD:

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated).

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

[snip]

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep

(2) irritability or outbursts of anger

(3) difficulty concentrating

(4) hypervigilance

(5) exaggerated startle response

I’ve never met Senator McCain. How do I know about the reactions described in "B" above? The same way any journalist would — through available medical records (or accounts thereof) and the senator’s own descriptions.

B. (1): According to the records, McCain has said that immediately after his release from military prison in Hanoi there were "times when very realistic or frightening memories" came back to him. But McCain "can successfully put these memories out of his mind," the medical records said.

How would I — or any journalist — know whether Senator McCain exhibits any behaviors or overt signs consistent with the symptoms in criteria "D" above? Well, many of the symptoms are easily observed.

Sadly, Senator John McCain is an elderly man with a history of irritability and anger so severe that he has had multiple episodes of workplace violence. His symptoms are so extreme that many of his fellow military professionals, among them naval aviators — men whose job description includes blowing things up and killing — publicly state McCain is too unstable to be Commander-in-Chief. Friday we learned McCain sometimes requires powerful prescription medication for sleep difficulties. He has also exhibited profound deficits in memory and recall — hallmarks of impaired concentration — on numerous occasions.

Sadly, he also has a history of multiple head injuries, chronic and severe alcohol abuse (including numerous "black-outs"), five hours of general anesthesia, and dizzy spells.

Traumatic symptoms can cause impaired memory and concentration — but the same symptoms may also be caused by multiple head injuries, chronic and severe alcohol abuse (especially abuse severe enough to cause "blackouts"), prolonged general anesthesia, and some of the medical conditions that cause recurrent episodes of dizziness.

Whether McCain’s frequent memory impairment is or not from traumatic symptoms, the fact of his symptoms of severe irritability and anger, together with his sleep disturbance, appear to satisfy criteria "D" for PTSD.

The WaPo article — subtitled Research Shown Past Trauma Probably Won’t Affect Candidate’s Life Span — fails to discuss any of the above. The WaPo’s piece instead focuses mostly on McCain’s life expectancy.

Yet PTSD is a brain condition. While it may affect longevity (and I sincerely hope that traumatic symptoms don’t shorten Senator McCain’s life), as voters we select presidential candidates for their capacity as Chief Executive, not their capacity to become centenarians.

The WaPo did interview Everett Alvarez Jr., a Vietnam POW who went on to serve as deputy administrator of veterans affairs in the Reagan administration, and while Alvarez’ recollections are — of course — to be respected, they nevertheless amount merely to assertions of health.

The WaPo also noted that:

Since his repatriation in 1973, [McCain] has occasionally been examined at the Robert E. Mitchell Center for Prisoner of War Studies, run by the Navy in Pensacola, Fla. However, [Jill] Hazelbaker said this week that the senator "has not for many years participated in any POW follow-up."

The WaPo did go on to discuss the results of the studies in which Senator McCain apparently did not participate.

While the WaPo couldn’t find space to review what is publicly known about Senator McCain’s possible PTSD symptoms, they did find space to interview Jill Hazelbacker:

Despite his painful and harrowing captivity, McCain has never received a diagnosis of post-traumatic stress disorder (PTSD) … Jill Hazelbacker said. The records being released today contain "no psychological material because McCain has not been treated for anything related to that in the time frame of records we are releasing," she said.

And who is Jill Hazelbacker, the authority the WaPo consulted to discuss this matter?

Senator McCain’s campaign spokesman.

Why am I less than convinced about this — or any — Prez candidate’s purported freedom from symptoms?

Why I am less than convinced the WaPo was actually trying to research an article, rather than echo the campaign outreach?

My friends, come back with me a moment — five weeks of moments, actually — on a journey across the vastness of time and the nanoworld of the WaPo editors’ collective synapses.

Back in the Halcyon Days of April, 2008 the WaPo told us:

….when McCain leaned toward Charles E. Grassley and slowly said, "My friend . . ." it seemed clear that ugliness was looming: While the plural "my friends" was usually a warm salutation from McCain, "my friend" was often a prelude to his most caustic attacks…. McCain became angrier, his fist pumping even faster….at some point, he mocked Grassley to his face and used a profanity to describe him. Grassley stood and, according to two participants at the meeting, told McCain, "I don’t have to take this. I think you should apologize."

McCain refused and stood to face Grassley. "There was some shouting and shoving between them, but no punches," recalls a spectator, who said that Nebraska Democrat Bob Kerrey helped break up the altercation.

Since the beginning of McCain’s public life, the many witnesses to his temper have had strikingly different reactions to it. Some depict McCain, now the presumptive Republican nominee for president, as an erratic hothead incapable of staying cool in the face of what he views as either disloyalty to him or irrational opposition to his ideas.

Of course, this won’t surprise FDL readers of sufficiently intact synaptic capacity and advanced years to recall the deeps of time — all the way back to a month ago, when Cliff Schecter joined us for Book Salon:

He was called McNasty in high school. The story I broke on his fight with Rick Renzi began with his calling him "boy." You brought up the wife story.

He likes abusing people. Being nasty to people. It is a part of who his is, a sadist, and the temper is only part of it.

Introducing that Book Salon, Jane brought up that same ancient WaPo article — the one that discussed McCain’s severely impaired emotional control and propensity for workplace violence:

But only this weekend, in the Washington Post article about McCain’s temper (which by all reports has McCain — with no small amount of irony — "furious"), McCain’s staff now confirms Cliff’s story about Renzi:

Reports recently surfaced of Rep. Rick Renzi, an Arizona Republican, taking offense when McCain called him "boy" once too often during a 2006 meeting, a story that McCain aides confirm while playing down its importance. "Renzi flared and he was prickly," McCain strategist Mark Salter said. "But there were no punches thrown or anything."

Nope. No PTSD symptoms there at all, right?

Senator McCain, from publicly available data, is only known to satisfy five of the six diagnostic criteria for PTSD (and he’d likely have to consent to direct interviewing to assess the sixth).

But the WaPo Villagers can’t seem to recall how they eagerly supported the catastrophe that was our 2003 invasion (and subsequent cccupation) of Iraq.

They can’t remember yesterday morning, much less last month.

Probably not the most reliable sources for psychiatric history.