Would you date a combat veteran with PTSD? Would you be okay with a death-saturated law enforcement officer as a neighbor? Would you reciprocate friendship with a seasoned, traumatized EMT? Public fear and stereotyping abound when it comes to psychological conditions. Serial murderers are as common as crows. Children with autism will throw a school into chaos. And people with trauma are erratic and suicidal or homicidal. The damage done by these stereotypes is incalculable.
Part of the blame game is the very system put in place to help. The mental health field’s diagnostic term “Post Traumatic Stress Disorder” is harmful.
“Disorder”
Ask a coworker, neighbor, or partner, what the word “psychological disorder” means to them. Chances are you’ll hear the word “disorder” implies a permanent emotional, condition. It means the person is damaged, weak, flawed, crazy, or doomed. In a word, they’re abnormal.
The label “Post Traumatic Stress Disorder” misses the mark for two reasons. First, an external trauma triggers a predictable physical cascade leading to psychological reactions. That’s how we are hard-wired. (See the previous post on “This Is Your Brain on Homicide” from 6/18/24.)
Second, traumatic conditions can be successfully treated. Traumatic reactions don’t have to become the psychological equivalent of a “terminal illness” – not when addressed early by competent clinicians or support persons in a safe environment. But when people buy into the stereotypes of feeling broken and beyond help, they avoid treatment. It’s like refusing to get a broken arm set and expecting it to heal without distortion. It’s not going to happen.
How Did We Get Here?
The field of mental health, like the field of medicine, evolves. For the most part, changes have brought improvements. But there’s still a way to go.
There have been five versions of the Diagnostic Statistical Manual (DSM). The first came out in 1952. It did not have a listing of PTSD. The closest two were “Anxiety Reaction” with the stipulation of “External Precipitating Stress,” and “Gross Stress Reaction” such as war.
By 1968, in the DSM II, this was dropped in favor of “adjustment reaction,” but this was vague and overlapped with another listing of “transient situational disturbance.”
The term PTSD did not actually appear in the diagnostic manual until the 1980 version, the DSM-III. This was the post-Vietnam War era. The listing was not without controversy. It addressed an important gap in the terminology by stipulating that the traumatic events must not only lie outside the individual, but are more than common stressors like financial loss, romantic rejection, or the natural death of a parent.
The term PTSD did not undergo significant change in the DSM III-R. However, the next revision, The DSM IV in 1994, did list important research-based criteria: the person must have been exposed to a catastrophic event involving actual or threatened death or injury (such as sexual assault or kidnapping), that results in negative cognitions, disruptive behaviors, avoidance, foreshortened future, among other criteria.
The 2013 version, the DSM 5, moved PTSD from anxiety disorders to a new category of “trauma and stressor-related disorders.” This was done to differentiate it as a condition brought about by external pressure. But did that do the job?
PTI and PTG
What if the nomenclature replaced the word “disorder” with “injury” (as in “Post Traumatic Injury“)? This clearly illustrates the external origin of this condition. The person wasn’t born with it. It could not be prevented. And the term “injury” raises hope. People can come back, can become functional, from injuries with proper treatment.
Why is this important? By reducing stigma and instilling hope, by emphasizing an external force versus a character flaw, by deliberately using the medical term “injury” it’s possible to weaken resistance to getting proper care. Isn’t that desirable?
With appropriate and timely support most people will recover from trauma. Even better, more than half will go on to develop Post Traumatic Growth (PTG). This transformation evolves from post-injury to a heightened state of resilience, determination, and insight.
Until the day when (or if) the formal diagnostic labels change, we can benefit by thinking and talking about traumatic conditions as an injury – not a disorder. It’s a no-fault diagnosis. The DSM VI will be released in the next year or so. Let’s see what happens.
