PTSD explained

The light went on in my head during a debate over PTSD nomenclature last year.imgres

Then-president of the American Psychiatric Association, John Oldham, was chairing a session entitled Combat-Related PTSD: Injury or Disorder? Today’s Time Magazine carries a no-nonsense article about what PTSD is, exactly.

“A stellar panel of trauma experts — retired generals, senior researchers and key framers of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — debated whether the term, post-traumatic stress disorder (PTSD) should be changed to post-traumatic stress injury (PTSI).

“Supporters of the change to “injury” argued that it might help overcome the stigma that many military members and veterans associate with seeking treatment for PTSD. Service members aren’t happy to report “a disorder” but might be willing to admit an injury. Those in opposition argued that “injury” is too imprecise a term for psychiatric diagnosis and treatment. As I sat through the heated session, it struck me that they were also implying that the term, disorder, is somehow “more scientific” and, therefore, “more psychiatric.”

“From the perspective of science, it seemed to me that the real question here was whether there is any evidence that changing the name of PTSD would actually promote health: neither side seemed interested in researching that very answerable question. This made me wonder if we were actually debating about science or, perhaps, whether we were arguing about something else. Following up on this year’s APA session in San Francisco last month (and, in particular, its 45-session Military Psychiatry track organized by Elspeth Cameron Ritchie, M.D., MPH, retired U.S. Army colonel and now chief medical officer for the District of Columbia’s Department of Mental Health) triggered that recollection, and others connecting to the vexing challenge of PTSD, or whatever you want to call it.

“Among the key questions that occurred to me was “Who is DSM, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, actually written for?”

“If for patients, shouldn’t its language be crafted to serve them best (and shouldn’t we be doing research to find out how it might best serve them)? If for professionals, do we psychiatrists really believe that treating injuries is less consistent with science or with the practice of medicine (or is somehow beneath our dignity) than the treatment of disorders?

“Don’t most physicians treat injuries? And might we be conflating medicine with science in worrying about being “precise” in describing mental disorders? While I’m all for precision, we don’t really know enough about the basic science of any mental disorder to be very precise in diagnosing or treating it. This is particularly so with PTSD, a complex clinical problem in which a stressful life experience perceived by the mind becomes an intricate and enduring problem of mind, body and society.”

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