A little known semantic battle in the military that has garnered considerable attention over the last year is whether or not the term “Post-Traumatic Stress Disorder” should be changed to “Post-Traumatic Stress.”
There are formidable supporters on both sides. In support of dropping the “D” from PTSD are former president George W. Bush, retired Army Vice Chief of Staff General Pete Chiarelli, and a number of veterans groups. On the other side is the not so insignificant American Psychiatric Association which controls the Diagnostic and Statistical Manual of Mental Disorders—the publication that has housed the diagnosis since 1980.
Like most professional debates within the mental health field, there is no clear right or wrong answer. If one were to look at the arguments on either side, the benefits and risks associated with both would become apparent.
And like most debates in general, those with the most power, money, and influence will come out on top. That’s what makes this particular debate interesting; both sides are overflowing with all three.
Stigma and Suggestion: How Much Does One Word Matter?
Those who support dropping the “D” believe that doing so will reduce the stigma associated with seeking help for PTSD, thereby increasing the number of troops who come forward. Stigma has been identified as a significant barrier with regard to troops seeking mental health care in all branches of the military.
Concerns over being labeled as weak or a coward have been noted as have concerns about negative impact on one’s career. Fortunately this stigma has improved over the last several years. However, it is by no means resolved.
Proponents of the name change also believe that equating the expected psychological consequences of combat experience to a psychiatric illness pathologizes normal reactions to abnormal experiences. In essence, it labels the soldier as sick, broken, and dysfunctional, when it actuality, the person may be experiencing a difficult but transient reaction.
And last, proponents believe that changing the current disorder to an “injury” will change the perception of the American public leading to greater acceptance of the traumatized men and women who reintegrate back into their communities after combat.
The Business of a Disorder: Research, Funding, and Reimbursement
Those who oppose the name change cite reasons that resonate primarily in academic and professional circles, but are nonetheless relevant and important. Corralling symptoms into distinct disorders allows researchers to determine which treatments work, identify those most at risk for developing the disorder, and possibly develop methods for preventing it.
Opponents also believe that removing the “disorder” distinction minimizes the often severe, long-term, and treatment resistant nature of the problem. In fact, for some, PTSD is a lifelong battle that significantly impacts quality and length of life.
And then there is the issue of compensation. PTSD is a compensable disorder in the military and Veterans Administration, and by minimizing the significance of the illness, much needed financial and healthcare benefits may be reduced.
Applying the Debate to Real Practice
As a psychologist who has ties to the academic and professional psychiatric circles and a veteran who sought help for post-traumatic stress, I see the merits to both sides of the debate. However, I’m not convinced that simply changing the name of the disorder will increase access to care for troops or change the perceptions of the American people.
An argument can be made that there is scant evidence supporting the notion that service members do not seek help for PTSD because of stigma. Most of what is available is anecdotal in nature.
In fact, the Veterans Administration is encountering record numbers of disability claims for PTSD when the prevalence of the disorder from Iraq and Afghanistan is considered to be equal to or less than previous conflicts. However, an easy counter to this point is that we have become better at identifying PTSD and have created a culture in which unconditional support is provided to those who have served, both which have led to increased disability claims.
Although the intentions of the proponents for the name change are sincere and based in respect and caring for our service members and veterans, the unintended consequences could be dire.
Comparing PTSD to a physical injury such as an ankle sprain could minimize the seriousness of the disorder. If that happens, troops may be embarrassed to seek help, considering they live in a culture that embraces a “suck it up and drive on” mentality.
And a shift in the general public’s perception about PTSD along similar lines could lead to less acceptance and understanding, as well as reduced funding to support research and treatment. Both would be an injury to the progress we’ve made over the past several decades in understanding PTSD.
*This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”
Photo courtesy of Sgt. Denoh Grear on flickr