Don't rename PTSD because you don't feel it

Get After It

Thoughts and observations from Perry Jefferies.

Yesterday was supposed to be National PTSD Awareness day, a PTSD highlight in PTSD month.  These types of days are good, I think, but with so many, can lose their impact.  PTSD is a condition that may affect a large percentage of America, or the world.  At any rate, many, many people have lived through conditions that might cause PTSD in someone.  Over the last few years, troops and veterans seem to own PTSD, although with better news reporting, we might realize that children in abusive homes or survivors of sexual assault might outnumber the military-oriented PTSD class.  And to be sure, although some vets might wear PTSD on their sleeves, many try to avoid naming it.  Or folks that have some level of stress, anxiety, guilt, or shame go to extreme lengths to not name PTSD as an injury to them.  So, we have Gen. Chiarelli’s quest to rename PTSD as PTS.  I was struck by talks at the recent Bush Institute Stand-To that attempted to rename PTSD as PTG. That’s a movement that focuses on the emotional growth and strength that can occur after a stressful incident.  For many in the service this does happen.  But some are not affected the same way.  And there is the growing body of writing about “Moral Injury” even if it has not been defined or logically differentiated from guilt and shame.  A recent article by some experts is pushing back on the MI advocates who claim that certain therapies are ineffective at treating it. 

So, even as we acknowledge the challenges of PTSD, we may minimize its pull on the veteran community.  Some without PTSD are pushed toward that compartmentalization even as some with are discouraged from naming their injury.  I think that these efforts may cause the rise of a new kind of stigma.  PTSD means Post Traumatic Stress Disorder – emphasis on disorder.  That does not mean that everyone that reacts to stress, even having lingering effects, has PTSD.  As IAVA’s Paul Rieckhoff says: no one can walk through a stream without getting wet, no one comes home from war unchanged.  Many of our vets, especially those in long-term asynchronous combat, will have effects.  They should.  Morally ambiguous situations should cause a thoughtful person to consider their actions.  Hearing about leadership failures should generate concerns.  Surviving a near-death situation should make you want to live your best life possible.  None of that is out of the norm.  But some people have serious and long-lasting negative effects.  They have continuing flashbacks.  They have continuing issues with isolation, appropriate behavior, anger, and more.  Increasingly, we are learning about identifiable physical effects.  Too many people turn to substance abuse to address the injury. Psychotherapy can help one deal with these symptoms but doesn’t always erase the lasting, physical changes that a disorder causes. 

We should not minimize the disorder for those that have it.  Don’t rename or sugarcoat this.  If farming or horse riding or fly-fishing or creating stories helped you deal with the reasonable consequences of war and combat that is great.  But we should not extend our personal experience to all other Vets.  Some research is now pointing to a disturbing observation about PTSD.  If those suffering certain effects are grouped, there is a three-tiered trend for vets.  Those with the worse, life-debilitating symptoms; those with moderate symptoms that can move through life with some major challenges; and those that have effects but are able to deal with them.  The problem is that people tend to stay in their track – they don’t get appreciably better.  The research is only a year or two old, but moving people from one track to a lower track has proved nearly impossible.  We should not confuse our resilience with the stark challenge that these severely injured people have.  If coming under fire or dealing with injured refugees gave you stress that you overcame and became a success – great.  But it’s not that way for everyone and I don’t think we should deny their injuries by fighting to rename a diagnosis to match our personal experience.  We would not tell someone with a compound fracture that we had shin splints so “let’s not say ‘broken leg’, let’s call it ‘running stress’.”

Some people have PTSD.  It is real.  It is an injury.  It does not need to be re-named.