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Facing Past Trauma, Part VI: The History of the PTSD Diagnosis

By John McManamy, Health Guide Saturday, July 07, 2012
This is the sixth in our conversation on past trauma. Last week we looked at how PTSD can guide our understanding into how trauma may connect to bipolar. There is, however, one major catch: The PTSD diagnosis had its roots in the observable phenomenon of soldiers mentally falling apart from the horro...
7/ 7/12 3:14pm

Well, you know where I stand on this.  It is one of the places that the DSM is unraveling under the force of the new brain science.  Why have two different diagnoses for two people who have the exact same thing going wrong in their brains, and producing the exact same symptoms?  A broken leg is a broken leg, whether the person fell thirty feet or three.

 

The latest twist is that the Armed Forces wants to tweak the name, call it "Post Traumatic Stress," and drop the "Disorder" part, because soldiers resist being labeled with a disorder.  Whatever -- the DSM is not science anymore anyway.  Just so long as the new "PTS" gets its reimbursement code, it's all good.

 

Meanwhile, the answer to Nancy's objection is not by assigning a diagnosis that the sufferer rejects and so refuses treatment, but rather, by recognizing that these are battle injuries and issuing a Purple Heart! 

John McManamy, Health Guide
7/ 7/12 3:33pm

Hey, Willa. Spot on!

 

To readers: My views on the PTSD diagnosis arose from earlier discussions with Willa, who a year or two ago posted this brilliant piece:

 

http://prozacmonologues.blogspot.com/2010/05/ptsd-and-dsm-science-and-politics-again.html

 

Willa is my favorite blogger. Please make her blog, Prozac Monologues, a habit.

7/ 7/12 4:37pm

Ah, shucks.

 

Additional thoughts about the sea change in which this conversation continues:

 

As people with mental illness find our voice and are formulating new categories of understanding, the coming concept is Trauma-Informed Care. It's not about "What is wrong with you?" -- Soldiers are not alone in finding that question to be less than helpful.  It's about "What happened to you?"

 

In trauma-informed care, symptoms don't describe what is wrong with you.  They describe the ways you have developed to cope with what has happened to you.

 

PTSD as a diagnosis has always been about interpreting the meaning of experience (is the soldier a coward, a malingerer, a failure, a casualty?)  Trauma-informed principles could transform how we treat veterans -- we, being both the health care system and the general public).

 

But dang it, here I am writing my blog post on your site again!

7/ 7/12 8:03pm

There is a song, titled "Stuck in a Moment" by U2.

 

It speaks resoundly to me.

For some, there is but only 1 moment that they "cannot get out of it".. and for many others, it may be several moments over time.

 

Yet with each defining moment, that we are "stuck" in and cannot seemingly get out of - or past... it does not really matter what that moment was... to me, it simply is something that occurred, that for whatever reason, HOLDS someone in one place in time... and rewinds itself again and again, having permeated intself so engrainly within our mental and physical fabric... that when something triggers... it plays again and again, often in some form or fashion so different than the original action.

 

It is a moment.. for which... you are stuck in.

 

I have a few of those... most notably my near fatal car wreck, I've mentioned here (likely ad nauseam) in March 2007... for which I cannot escape from.

 

My life was "before the accident" and "since the accident", so profoundly changed - the 2 sides of that 1 event most recent.

 

"...Oh love, look at you now
You've got yourself stuck in a moment
And you can't get out of it

...I wasn't jumping, for me it was a fall
It's a long way down to nothing at all ...

...Don't say that later will be better...


...And if the night runs over
And if the day won't last
And if our way should falter
Along the stony pass

 

It's just a moment
This time will pass."

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By John McManamy, Health Guide— Last Modified: 07/09/12, First Published: 07/07/12