PTSD: What`s in a Name?

In the May 28^thissue of Newsweek, author and marine Anthony Swofford writes “All across Americas veterans are committing suicide at unprecedented rates…”.  According to Swodford about 18 veterans kill themselves each day and the total is estimated to be larger than the all the combat fatalities in Afghanistan and Iraq combined (6,460).

From first-hand experience Swofford describes the great loneliness and isolation veterans experience when the stress-induced intoxication of combat subsides and the comradeship and cohesion that lent support no longer exists. There seems to have been a sea  change in how combat experience is affecting veterans in regard to suicidality. Swofford points to (1) the stresses of multiple deployment; (2) the training and experience that teaches young warriors that weapons and violence are  possible solutions to life problems; and (3) how the lack of civilian sacrifice and awareness of the conflict often results in the war--and subsequently, the veterans who fight it--being marginalized in mainstream culture.  

About one-third of veterans from the Iraq and Afghanistan wars have psychological problems such as Trauma Brain Injury (TBI) or  post-traumatic stress disorder (PTSD). Increasingly, it is apparent that behavioral heath services for veterans are inadequate or inaccessible.  

A recent National Council for Community Behavioral Healthcare survey of its providers cited “stigma” as one of the four most serious roadblocks that prevent veterans from getting treatment for PTSD. The other roadblocks are access to care, long distances, and lack of family involvement .

Calling PTSD a 'disorder' keeps vets from seeking help, says California District 75 Assemblyman Nathan Fletcher, who served two overseas tours of duty in the U.S. Marine Corps. Fletcher says, "The first thing we need to do is stop calling it post-traumatic stress 'disorder.' Who would admit they have a disorder? It's more like an injury. [Troops] are proud of their injuries," said Fletcher, who added that "there is a stigma to having a 'disorder'."...

A public hearing  was held in Philadelphia on May 7 to draw attention to  the military’s efforts to replace the word "disorder" with the word "injury” to reduce the stigma and perceived shame associated with having a psychological disorder. Recently retired General Peter Chiarelli has said, “No 19-year-old kid wants to be told he’s got a disorder.”  

With the DSM-V right around the corner, many think that this the best time to make such a change. Pentagon officials, like Chiarelli, have tried using the term  “Post-Traumatic Stress," but this has not caught on since the provider community and some advocates are concerned about not having  a legitimate DSM category with which they can bill for services or support clients' applications for disability benefits.

Supporters suggest that the term “injury” is more optimistic since it implies that the condition can heal and that it is the result of external forces, forces beyond the individual’s control.

Personally I think the change in DSM nomenclature might have some benefit, although the billing and disability issues certainly need to be ironed out first. I like the idea that the courage of our troops is honored in this way and it may even help us recognize the terrific courage of some of our other trauma patients, such as sexually abused children.

I also think that many will be disappointed in that the perceived “shame and stigma” won’t just evaporate by changing the name of a disorder--PTSD--to that of an injury--PTSI, or something like it. There will still be resistance to seeing “mental health providers,” especially those without the combat experience that brings a deeper understanding of the issues involved. I think the longer term answer may reside in the recovery model,  creating  new roles for peer providers, and reducing the effects of stigma for all Americans.  Perhaps the growing and dramatic visibility of  the veterans’  needs can help our society start to address the broader issue of discrimination against all of our disabled citizens.  What do you think?