There is a push within the military to eliminate the term “disorder” from PTSD. It sounds like a good idea. But is it?
By Dr. Mark Hammel
With the publication of DSM-III in 1980, Vietnam veterans finally had a diagnosis for their afflictions of war. When I began my Veterans Administration psychology internship in the fall of 1981, the diagnosis was still controversial. The old guard continued to insist that the symptoms we now take for granted as Post Traumatic Stress Disorder (PTSD) were, in fact, attributable to paranoid schizophrenia.
We are now faced with a movement, primarily from military brass, that would confuse the meaning of Post Traumatic Stress such that it no longer represents an injury. That is to be accomplished by removing the word disorder and redefining Post Traumatic Stress as being the normal reaction to the stress of war and other stressors. Not surprisingly, the idea of disorder is abhorrent to the military.
However excellent the idea of destigmatizing the normal reaction to stress might be; this is precisely the wrong way to go about it. When one parses the term post traumatic stress disorder, one finds two elements that connote pathology. The first is, of course, disorder. But the second and perhaps the more decisive is trauma, derived from the Greek for wound. Alas, we already have a time-honored term that defines the normal nonpathological biopsychosocial response to stress: the human stress response. When the severity of a stressor, in combination with the vulnerability of the individual, results in damage to the stress response system, we can speak of traumatic stress. When there is no damage to the system, the individual returns to a state of homeostasis and does not need clinical attention. When a force damages the system it cannot cope with, we speak of traumatic stress, and the need for clinical care. Where there is no damage, there is no traumatic stress.
We need to be aware of the giants on whose shoulders we stand. From Walter Cannon and his work on stress and homeostasis, Hans Selye and stress theory, and especially the intrepid band of mental health professionals and researchers who worked through the 1970s to turn the ship of DSM in a new direction inclusive of traumatic stress. Thus the gap was filled in the psychiatric vocabulary and the practice of healing the afflicted.
Let us not tamper with the integrity of a time-honored concept; let traumatic stress always connote an injury.