The following individuals and organizations support changing Post Traumatic Stress Disorder to Post Traumatic Stress Injury.
Bertram S. Brown, MD, MPH
I support the proposed name change from Post-traumatic Stress Disorder to Post-Traumatic Stress Injury.
This support and recommendation is based on more than a half century of psychiatric experience.
My first contact with this issue in 1954 was as a medical student working in an Army recruiting program at the Walter Reed Hospital neurology wards. Dealing with complex neuro-psychiatric problems of Korean war veterans, the terms, “shell shock” and “combat stress” were still being used to describe injured soldiers.
A more recent experience dealing with these same clinical complexities, (1990 – 2005), was confirmed when I served as the medical director of the “Civilian External Peer Review” program – a Department of Defense contract to help implement the quality assurance efforts of medical care in military hospitals.
From these “book end” experiences, and the intervening decades, I have come to a clear conviction:
The change of PTSD to PTSI will NOT change the basics of the biology and clinical manifestations of this diagnosis.
It WILL provide a sense of dignity to the men and women and their families who were injured when they were in “harm’s way”.
The stigma of “disorder” as contrasted with the clarity of “injury” will serve not only the military but impact our whole society.
Bertram S Brown, MD, MPH
Life Fellow, APA
Former Director, NIMH
Rear Admiral (ret.) USPHS
It’s easier to disqualify the evidence of cruelty than to end it, especially if that cruelty has been made to seem as inevitable as sexualized violence or war itself. A step toward revealing the cost of such cruelty — and our will to end it — is to stop stigmatizing the victim. The simple act of changing the diagnosis of Post Traumatic Stress Disorder to Post Traumatic Stress Injury would help to make clear that the injured party is not at fault. Naming reality is the first step toward making it visible — and changing it.
Writer and activist
Service Women’s Action Network
Service Women’s Action Network fully supports the movement to change the name “Post Traumatic Stress Disorder”. The natural human reaction to a life-threatening incident should not be labeled a disorder. The stigma mental health conditions carry in the military community prevents veterans from seeking the critical treatment they need to recover from combat and other service-connected traumas, such as military sexual violence and domestic violence. As a community, we must do everything we can to reduce the stigma of post-traumatic stress and welcome our troops home with compassion and open arms.
Executive Director, Service Women’s Action Network
Former Marine Corps Captain
Men and women who have been raped while serving on active duty have not only one stressor to deal with, but two. First the rape itself, and then (in most cases) the retaliation by the command after reporting. Military sexual Trauma (MST), according to DoD occurs 52 times a day.
When MST survivors seek help, they are then traumatize a third time. They are told they have a “Mental Disorder.”
In the interest of making things simple and acceptable for our active duty and veterans to seek help as well as our families and society to accept them, I endorse this change.
The daily struggles of our veterans are far more difficult than most imagine them to be. Suicides continue at the rate of 18 per day, veterans are invisible and benefits such as medical care are not being accessed because of this very issue. Changing this from disorder to injury in the medical field will open the doors to those who need it most.
Founder and Director of VetWow
MST Advocacy since 1996
National Center for Victims of Crime
We support changing the name Posttraumatic Stress Disorder (PTSD) to Posttraumatic Stress Injury (PTSI) as requested by General (Ret) Peter Chiarelli.
The National Center for Victims of Crime is the nation’s leading resource and advocacy organization for crime victims and those who serve them. Since its inception in 1985, the National Center has worked with grassroots organizations and criminal justice agencies throughout the United States serving millions of crime victims. The mission of the National Center for Victims of Crime is to forge a national commitment to help victims of crime rebuild their lives. We are dedicated to serving individuals, families, and communities harmed by crime.
Victims of crime have long met with prejudice and medical difficulties due to the wording of their damages implying a mental disorder as opposed to a medical injury. To change PTSD to PTSI would mean physicians believe that brain physiology has been injured by exposure to some external force. As noted in the letter from Drs. Ochberg and Shay to the president of the American Psychiatric Association, “The injury of PTSD is not necessarily permanent, but in chronic and complex cases, the injury remains for a long time and may be tolerated or may be seriously disabling. To those who live with the impact, PTSD is an injury–and a painful one at that.” This change in language to a justifiable injury model will help our constituents.
We agree that “The science supports an injury model, and the time has come to do what we can do to lessen the stigma and shame that inhibits our patients from receiving our help.”
Mai Fernandez Mark Mandell
Executive Director Chair, Board of Directors
I strongly endorse the campaign to change the name PTSD to PTSI because words and labels can have profound consequences. As others have already stated quite eloquently, we know two things about this issue.We know that the term injury accurately reflects the nature of the condition. We also know that changing the name of this condition would undoubtedly benefit millions of people who suffer from it.If either one of these statements were not true, I would understand the resistance to change–but they are both true. We have so very much to gain from this new term and absolutely nothing to lose.
Associate Professor, Pace University
Author, Parallel Justice for Victims of Crime
The Academy for Critical Incident Analysis at John Jay College strongly endorses the change in language from disorder to injury. While some may miss the significance of the change, ACIA believes it will enable victims to find their place in society and seek the help they need to recover fully.
The Academy for Critical Incident Analysis
I commend your thoughtful, important, compassionate work and support your efforts to drop the “D.”
In the past year I’ve spoken with many traumatized veterans from past and current conflicts for a documentary I’m making, which explores the complex question of healing “after” a war. In these intimate conversations, we don’t use the word “disorder.” It’s not a rule, it’s more an unspoken understanding: the word diminishes the deep, invisible wounds of war and stigmatizes the soldier who carries them home.
Words matter. Words have repercussions. A “disorder” implies a weakness, a deficit. It is an unrealistic description of women and men who, in our names, have seen, experienced and sacrificed more than most of us can fathom. “Injury” is not only more realistic, it suggests the possibility of healing, which is the first of many, many things we owe these veterans.
Frank Ochberg, MD
I encourage everyone who believes that the stigma of PTSD will be reduced by changing the name to PTSI to express your belief here.
For close to a year, I have asked my patients, their loved ones, and those who advocate for their welfare about this name change, and they tell me, in overwhelming numbers, “Yes. Change the name to injury. That will help.”
I ask journalists and journalism students, because I have been working closely with journalists who cover trauma. They say, “Yes. Injury is less stigmatizing.” (Not all reporters, but most who speak with me).
I ask leaders of veterans’ organizations from the Vietnam generation and from the current wars. “Yes,” they tell me. Sometimes they add, “That would help our effort to get a Purple Heart for PTSD.” The veterans’ organization, Honor For All, agrees. The mentors who work with my local Veterans’ Court agree — unanimously!
When I point this out to friends on the DSM committee of the APA, they do not agree. Some ask that the issue be studied – “Where is the evidence?” Some say, “It wouldn’t make a difference.” Some disagree that PTSD is an injury. They believe it is a mental illness, with a genetic predisposition. As Jonathan Shay and I argue in our letter to APA President John Oldham, there is a strong case to be made for the injury model of PTSD — certainly equally strong if not stronger than the mental illness model of PTSD. And if injury is a defensible medical term for a condition, and if that term adds hope and honor and dignity to those who qualify for the diagnosis, why retain a label that has come, through time, to add salt to a wound?
This is not a trivial matter. One in four women are raped in a lifetime. Most women who are forcibly raped have PTSD. Half the Vietnam combat vets from “high war zone action” had the symptoms that we now know as PTSD. One quarter of the journalists who cover war have PTSD. And many victims of violence and war never come forward due to the stigma of being labeled. Untreated PTSD raises the risk of suicide. Untreated PTSD leaves veterans and survivors of cruelty and catastrophe outside the embrace of the healing human group.
Of course, some stigma will remain no matter what we do. Trauma causes a certain amount of self-negation. But changing the name from PTSD to PTSI is one step in the right direction and it will encourage other steps forward. More veterans and survivors of violence will come forward. We will take this condition into the main stream.
And instead of equating PTSD with rampage killers or with malingerers seeking benefits, we will honor the millions of Americans with this injury. We will welcome them. They will respect themselves.
Frank M Ochberg, MD
Clinical Professor of Psychiatry, Michigan State University
Former Associate Director, NIMH
Honor for ALL
As Executive Director of Honor For ALL, a veterans’ organization dedicated to ending the stigma of invisible wounds, I am involved daily with the social inadequacies resulting from the stigma of PTSD. On behalf of Honor for ALL, I strongly endorse the campaign to change the name Post-traumatic Stress Disorder to Post-traumatic Stress Injury.
The word “disorder” in the very name of the condition is a primary and singular source of stigma. By simply changing that word we can redirect all succeeding efforts to alter the way we perceive invisible wounds and mental health in general.
Identifying the condition as an injury can and will help the effort to revise the criteria for the Purple Heart, an honor now unjustly denied the recipients of this battle-borne wound.
Not until we end the stigma can we expect to attenuate the current rate of veteran suicide and restore dignity to the families of those already fallen.
I applaud the efforts of Drs. Frank Ochberg and Jonathan Shay and sincerely hope the American Psychiatric Association will seriously consider their recommendation to change the identifying character of the condition from a disorder to an injury.
President, Honor for ALL
Carl C. Bell, M.D.
Language matters, particularly language that comes to characterize the heart and soul of a human being. When we in the APA first defined PTSD, we labeled a condition. But now it is abundantly clear that the condition is defining the person. In the singular case of PTSD, unlike other diagnoses,
we can improve self-esteem and public respect by relabeling this condition an Injury rather than a Disorder. The term, injury, is accurate and honorable. I support the effort underway to change the name PTSD to PTSI.
Carl C. Bell, M.D.
President/C.E.O. Community Mental Health Council
Acting Director, Institute for Juvenile Research and Professor,
Department of Psychiatry and School of Public Health
It is time to recognize that Posttraumatic Stress Disorder does not adequately capture the full spectrum of trauma reactions and service requirements our clients deserve. The traumatized require a far more nuanced and sophisticated category of recovery.
The recent discoveries in the neurobiology of memory are close to guiding us in a far more effective way of helping the traumatized manage their memory not unlike the way physical brain damage requires speech therapy. The focus on injury is rehabilitation toward functionality. The same should be true for traumatic stress injuries.
With hindsight we can all see that it was a mistake approving a syndrome named a disorder rather than an injury.
We who study, care for, and know traumatized people believe that they deserve to be treated in a way that is consistent with their injuries with methods that work and do not cause other problems. This is especially true for war veterans and their families who turn to us for help.
I strongly support the change from PTSD to PTSI.
Charles Figley, PhD
University Professor, Tulane University
Founding President, ISTSS
For years I shunned my own father because I thought something was inherently wrong with him. I knew he had Post Traumatic Stress Disorder from Vietnam, and I was more afraid of his condition (and of him) because the word “disorder ” frightened me so. “Disorder” dehumanized my father’s experience and made him sound more like a man who wasn’t tough enough or mentally stable enough to fight a war and seamlessly integrate himself back into society. He viewed himself as weak–largely, I believe, because of the stigma behind his diagnosis–and is still unable to see himself as a man who was injured by external forces, rather than a man who was deeply affected by the things he experienced because he wasn’t strong enough within. I fully support the change of Post Traumatic Stress Disorder to Post Traumatic Stress Injury–for my father, and for all young men and women everywhere who have served and are living with the stigma of a diagnosis with a connotation steeped in injustice.
Christal Presley, Ph.D, author of Thirty Days with My Father: Finding Peace from Wartime PTSD and founder of United Children of Veterans
Marla Handy, PhD
I strongly encourage changing the name of this condition from Post Traumatic Stress Disorder to Post Traumatic Stress Injury. Not only do I believe it more accurately describes the condition as one that is acquired as the result of forces external to the person (much like closed-head injuries), but it provides for new definitions of, and therefore opportunities for, healing. If the condition is defined as a disorder, then healing is defined as getting oneself back in order, returning to one’s pre-traumatic event state. That may be possible for those with acute symptoms following a single traumatic event, much like a bruised forehead will heal after a fall. But for those of us who have had symptoms lasting long enough to be considered chronic, that is not possible. Yes, we may have had the bruise, but we also have a lasting internal injury (from stress responses) that requires a different approach to healing, one of symptom management and accommodation.
It may be frustrating to live with an injury, but there is no need to apologize for it. There is no stigma attached to losing an eye. There is no social or personal expectation that, with enough effort or will, one could get oneself “back in order” and grow a new eye.
Accepting that I have an injury has been key to my ability to make peace with living with PTSD. Based on responses to my book No Comfort Zone: Notes on Living with Post Traumatic Stress Disorder, this concept has also brought peace, reduced shame and assisted in treatment for others.
Marla Handy, PhD
Author, No Comfort Zone: Notes on Living with Post Traumatic Stress Disorder
Laurie Barkin RN, MS
As a psychiatric nurse and writer who has worked with many survivors of traumatic injuries, I enthusiastically support changing PTSD to PTSI. Being “injured” implies hope of healing and a process of recovery. Being “disordered” implies a static state of derangement, and we all know about the stigma associated with that. The very least we can do for those who have sacrificed so much is to acknowledge the power of words and to demonstrate sensitivity in choosing them.
Laurie Barkin RN, MS
Author, The Comfort Garden: Tales from the Trauma Unit
Bridget C. Cantrell, PH.D.
Yes I agree the word “disorder” must be dropped. A warrior is intrinsically reliant and if the words we use as clinicians and loved ones portray someone who is broken disordered we have reinforced a very negative self concept. This further perpetuates the stigmas that prevent and hinder our warriors from coming forward to first off admit they could use some help. I might even goes as far to say …”wound” a wounding occurs in their mind, body and Spirit by a traumatic situation. This is not a disorder, it is part of the fabric of a warrior who has seen so much. We must reframe this on behalf of humanity Post Traumatic Stress must be embraced so one can learn about every aspect in order to manage the symptoms , learn about how to recognize their new skill set and this done by normalizing and the disorder gets in the way.
Bridget C. Cantrell, PH.D.
Military Family Network™
The Military Family Network™ mission is the success and well being of the military community. Since our inception, we have communicated with hundreds of thousands of service members, Veterans and their families who have shared their experiences, thoughts and feelings with us about the aspects of military life including deployment, separation, stress, depression, combat, trauma and loss.
The effects of trauma and the subsequent post traumatic stress it may induce is not borne by the individual alone; more and more research is discovering that families -especially spouses and children – and even friends, neighbors, employers, colleagues and others may be affected. It can be a cascading effect that ripples through the fabric of our communities.
This is why Military Family Network™ supports initiatives that seek to improve the lives of our service members, Veterans and their families and communities. We especially support those efforts that improve opportunity and access to quality care, treatment and early intervention without judgment or fear of consequence.
Therefore, we laud the efforts of General (Ret) Peter Chiarelli , Dr. Frank Ochberg, Jonathan Shay, MD, PhD, the organization Gift From Within and others for their efforts to change the term “Post Traumatic Stress Disorder” to “Post Traumatic Stress Injury” in advance of the next edition of the Diagnostic and Statistical Manual in May, 2013.
This initiative is very important work. With so many combat-experienced service members returning to our communities, any undertaking to assist their transition and ease their reunification with their families and communities will be instrumental to their success and ours.
Founder and Executive Vice President
Military Family Network™
I am a medical doctor who has become a journalism professor in Tbilisi, Georgia. On behalf of the Caucasus School of Journalism and Media Management of the Georgian Institute of Public Affairs, I write to support the initiative on shifting the name PTSD from disorder to injury.
Since 2005, CSJMM has worked with the Dart Center for Journalism and Trauma, and the trauma therapists at the Georgia Institute for Psychotraumatology. These are much-valued relationships. Trauma reporting has been taught at CSJMM since 2007. We find that the word, disorder, is discouraging, but the word, injury, is not.
I believe this initiative will support hundreds of Georgian men who have served in Iraq or Afghanistan and those who have participated in the wars with Russia over Abkhazia and South Ossetia, many of whom are finding difficult to adjust to life back home and whose voices are rarely heard in the Georgian mainstream media. This is due to lack of understanding of the problem by local journalists and also because of the existing taboo and stigma: Veterans are not able to identify the symptoms, journalists are not able to cover the problem and society is not informed. It is a vicious cycle that prevents progress by all involved parties.
I believe that proper wording matters and it will have an impact on journalists and their reports, on veterans, their family members and friends, and society overall.
Assistant Professor and Program Coordinator
Georgian Society of Psychotrauma
We, Georgian professionals working in trauma care strongly agree with the proposed shift of paradigm in the field of psychotraumatology. Shifting from “disorder” to “injury” will support traumatized people to overcome marginalization and win their struggle with trauma. That will assist professionals, helpers, states – to be more efficient in providing assistance.
The words do have power – they frame reality, create discourse, shape policies; they also make difference. And that’s what we need in the field of trauma care – a Change, making the system of responses client-centered and resilience-based.
The South Caucasus, due to the wave of armed conflicts which it went through since nineties of the last Century, is one of the regions heavily suffering of PTS(D). That is especially true for Georgia, where people forced to leave their homeland (IDPs –Internally Displaced Persons) make up approx. 8% of the country population. The recent war with Russia (August, 2008) significantly enlarged the population of traumatized individuals. Following it there was a case of IDP lady who has burned herself publicly and thus articulated her SOS. And the main thought in response, provoked by this incident in the mind of general public, authorities, journalists – was about her mental disorder, while for us, professionals working with the traumatized people, that was not about disorder; that was trauma and social exclusion, which led her (and us) to the tragedy.
In April of 2011, while in Tbilisi, Dr. Frank Ochberg, at his master class delivered for Georgian professionals working in the field of trauma care shared idea of shifting the paradigm which was a huge insight to us: the new, client-friendly “injury” frame enhances potential for professional help and social inclusion. That is especially important taking into consideration that in most of the cases trauma is about social isolation. Therefore, Georgian Society of Psychotrauma strongly votes for the proposed change.
Nino Makhashvili, MD Jana Javakhishvili
President, Georgian Society of Psychotrauma, Founding Board Member,
Director, Global Initiative on Psychiatry – Tbilisi Georgian Society of Psychotrauma,
CP of Dart Centre in South Caucasus
Dr. (COL) Kathy Platoni
I applaud and celebrate the courageous stand taken by this group to at long last, remove the” sting” of the disorder label from the upcoming DSM V. The stigma and the shame associated with this terminology, indeed sends so many suffering souls running far and fast from the treatment room, slamming that door shut to assure that all hopes of betterment and being able to come all the way home are laid to waste. We can ill afford to perpetuate the illness model for the thousands who continue to function at home and on the battlefield with Post-Traumatic Stress Injury for the very reason that they have had the courage to face these demons, to adapt, and to overcome. “Disorder” connotes otherwise. We can ill afford to forget that trauma is haunting and unforgettable, yet reactions to the catastrophic are unquestionably not disordered, but normal responses to that which lies far beyond the realm of the normal range of human experience. Drop the term and throw open the bomb bay doors to promote the desperately needed treatment of wounds that do not bleed.
Kathy Platoni, Psy.D.
COL/US Army Reserve
Army Reserve Psychology Consultant
Co-Editor, with Raymond M. Scurfield, DSW of War Trauma In Its Wake ~Expanding the Circle of Healing (in press, 2012) and Healing War Trauma~A Handbook of Creative Approaches (in press, 2013)
Elspeth C. Ritchie, MD, MPH
I want to add to the debate on the hot issue at the American Psychiatric Association this week. Retired Army general and vice chief of staff Peter Chiarelli made a strong case for re-naming post-traumatic stress disorder, or PTSD. Chiarelli advocates calling it post-traumatic stress injury. The Canadians use the term “operational stress injury” or OSI. The U.S. Marines have advocated the injury concept for a while.
Before, I was not in favor of the name change. Psychological reactions to war have been called by many names: shell shock; not yet diagnosed, nervous; battle fatigue; combat stress reaction; and of course PTSD. Does the name really make a difference?
I have said, and still believe, that the most important issue is how Soldiers and other service members are treated by the military and by society. That is the most important component to stigma.
But I am changing my opinion on nomenclature. If indeed, Soldiers are more likely to seek medical care if the term used is “injury”, rather than “disorder”, it is worth a try.
Basically Soldiers hate to go see therapist who ask them about all their problems, and imply that the problem is with them. “I would rather kill myself than go to a shrink” is a not-uncommon statement. Although there are evidence-based therapies, such as cognitive behavioral therapy, if the Soldiers will not go, how effective are they?
And if indeed, 20 to 30% of Soldiers are developing post-traumatic stress symptoms, is it really a disorder, or simply a common reaction to the horrendous stresses of combat?
There were a number of other relevant sessions at the APA, which discussed more acceptable routes to care, including so called complete and alternative treatment (CAM) or integrated care. They include virtual reality, acupuncture, yoga, and therapy dogs.
Now there is another critically important aspect, which is the implication for the disability system. Currently Soldiers with PTSD receive 50% disability. There are concerns about whether changing the label would affect the disability rating. We would have to work through that, to ensure that there are not significant unintended consequences.
Nevertheless if we could combine a more acceptable label with treatments that Soldiers would go to, it would be huge benefit to all.
COL(Ret) Elspeth Cameron Ritchie, MD, MPH
Chief Clinical Officer, Department of Mental Health, Washington, DC
Professor of Psychiatry, Uniformed Services University of the Health Sciences
Former Psychiatry Consultant, US Army Surgeon General
Mike L Harreld, M.Div
In my work as a hospital chaplain, I have worked with many persons, veterans and civilians who are experiencing what we know to be PTSD or Post-Traumatic Stress Disorder. Individuals, especially military personnel do not wish to be labeled with a disorder.
For the military specifically this label can go with them and hinder their opportunities for service and a promotion.
A disorder is often seen as untreatable, where an injury is something that is treatable. I believe it is in the best interest of all if the name were to be changed from Post Traumatic Stress Disorder to Post Traumatic Stress Injury.
I support the proposed name change from Post Traumatic Stress Disorder to Post Traumatic Stress Injury.This support and recommendation is based on 40 years as President of the Falk Foundation, directing funding to programs in the public mental health field, academic psychiatry, psychiatric policy and infrastructure, and community based psychiatric programs.The current PTSD definition carries a level of stigma not unlike that about mental illness broadly held by society until relatively recently. For affected combat veterans, the terminology becomes a double jeopardy when added to a less than enthusiastic reception facing many in the employment field and social reintegration. Replacing the vague term “disorder” with the specific and treatable “injury” will provide a legitimacy and definition more easily understood by the society that these men and women have so massively sacrificed for.As one senior psychiatric official has stated, “The stigma of “disorder,” as contrasted to the clarity of “injury,” will serve not only the military, but impact our whole society.
Philip B. Hallen
Falk Foundation, Pittsburgh, PA
Dr. Richard Lippin
As former Chair of the Mental Health Committee of the American College of Occupational and Environmental Medicine (ACOEM) (1996-2001) and as the only physician named as a member of the National Institute of Occupational Health and Safety (NIOSH)research team charged to study the impact of stress on worker health and safety (1997-2001) I fully endorse the proposed name change from Post Traumatic Stress Disorder to Post Traumatic Stress Injury. I view the soldier as a special category of “worker” whose injuries and illnesses sustained in defense of our nation as especially important as it relates to attribution of the injury/illness to their unique work verses attribution to home stresses or personality traits. The word “injury” more accurately reflects work related, externally imposed, causality of injuries and illnesses verses the word “disorder” which can be more widely interpreted to reflect internal non work related causality or character flaws at best- victim blaming at worst.
Richard A. Lippin MD, FACOEM
My husband Major John Ruocco USMC died by suicide on February 7, 2005. During his fifteen years of service in the Marine Corp John was exposed to multiple traumatic events in a combat setting as well as in training. He suffered psychological injuries on each of these occasions, however refused to seek help for fear of how it would effect his career and how it would change the way people viewed him. The night my husband died I begged him to get help, he agreed to do it but said “I’m going to lose everything”. He never did go for help. John killed himself later that evening.
It’s been seven years since the death of my husband. I am now the Director of POSTVENTION Programs for the Tragedy Assistance Program for Survivors (TAPS). In the role I develop peer based support for thousands of survivors who are grieving the death of a service member to suicide. Each new family provides a small window into the struggles of our Service members prior to their death. What saddens me the most is that their is still such enormous stigma around seeking help for psychological injury due to their service.. I have come to believe that a piece of this stigma lies in how these injuries are being labeled….disorder implies something wrong with you, while injury implies something that happened to you.
I don’t know if changing the diagnosis from disorder to injury would of saved my husbands life , but I do think that there is a much greater chance that he would of gone for help if he thought others considered his struggle to be an injury. We MUST do EVERYTHING we can to fight this stigma and to label PTS for what it is….an injury.
Director of POSTVENTION Programs
CAPT William P. Nash, Medical Corps, USN (Retired)
The time has come for all of us — in and out of healthcare, in and out of the military — to challenge our own long-held conceptions about whether the observable manifestations of posttraumatic stress reflect a real rather than merely metaphorical injury to the person. The clues are there for anyone to find if they’re looking.
One source of clues are the subjective experiences of the traumatized. They know something has happened to them, something outside their control that cannot be undone. Even if their symptoms fully resolve, they are changed forever by their traumatic experiences. Another source of clues is the great similarity of post-event symptoms experienced by survivors of life-threatening events like accidents or assaults, losses of cherished people and things, and events that shatter deeply held beliefs, especially those of a moral nature. Posttraumatic stress simply cannot be only about fear conditioning. And finally, at long last, neuroscience is beginning to provide clues to how intense or prolonged stress can inflict literal injuries to circuits in the brain that are absolutely fundamental to personhood.
Every time I have explained these reasons for considering posttraumatic stress a literal injury to military Service member or veteran patients I have heard them breathe sighs of relief. Their distress and changes in functioning are NOT their personal fault.
I see two issues being raised by this important campaign. Should we relabel PTSD Posttraumatic Stress Injury because to do so would reduce shame, blame, and fear of acknowledging and asking for help for stress-related problems? And is bio-psycho-social-spiritual trauma REALLY an injury to the whole person rather than something that can be shrugged off, unlearned, or successfully ignored?
I for one, am DELIGHTED we are having this conversation.
Bill Nash, MD
Former Navy psychiatrist deployed with 1st Marine Division to Operation Iraqi Freedom-II
Former director of US Marine Corps Combat and Operational Stress Control programs
Researcher in combat-related posttraumatic stress
Steven M. Gorelick, PhD
Over two decades ago, I developed and began to teach an undergraduate course at Hunter College examining the impact of language on our collective understanding of illness, natural disasters, violence, and many other painful challenges to social and personal well-being.
As I think back on all the changes in our collective attitudes, language, and behavior during this time, one trend seems to be constant: Again and again, we have chosen to eventually jettison labels and names that we realized were vestiges of eras in which – unable to fully understand the complexity of a problem — we resorted to blaming victims rather than struggling to understand.
Susan Sontag’s seminal 1978 essay – Illness as Metaphor – provided an especially eloquent explanation of how and why we have been so shamefully prone to loathing those in pain. Terrified at our impotence in the face of the scourges of tuberculosis, cancer, and HIV/AIDS, we adopted cruel and stigmatizing language and narratives tracing illness to human weakness and destructive human behavior. It was them, not us. What a relief.
It is almost impossible to believe some of the bizarre and cruel folk-theories we came up with, chastising cancer patients for emotional repression or suggesting that HIV/AIDS was some sort of divine retribution for sinful behavior. Eventually, and often only after fierce resistance by those unfairly stigmatized, we moved from the hurtful to the humane.
And now it’s time to do the same with PTSD.
The pioneers who developed this diagnosis intended a clear departure from the language of battle fatigue, shell shock, and “war neurosis,” rejecting the idea that it was the neurosis rather than the trauma that destroyed lives. Over time, though, the term “disorder” has led far too many people to see such trauma as outside the boundaries of normal human behavior; as a pathological rather than understandable reaction to prolonged trauma.
And that’s why it has to go.
If we learned anything from the most lethal century in human history, it’s that trauma exacts a painful and lasting price from many of those who face it in war, catastrophe, and other less extreme settings. To continue to use the term “disorder,” widely and popularly understood to suggest some peculiar pathology, is to willfully ignore our collective responsibility for the pain and suffering that is anything but peculiar when we repeatedly ask people to use violence and force to clean up our political messes.
The injured are not peculiar. They are injured. And only a change to “Post-Traumatic Stress Injury” will make it absolutely clear that we are rejecting victim-blaming and unflinchingly facing the collective social failures that made pervasive injury inevitable.
Steven M. Gorelick, PhD
Professor of Media Studies, Hunter College