Althouse: Should "post-traumatic stress disorder" be renamed "post-traumatic stress injury"?

May 7, 2012

Should "post-traumatic stress disorder" be renamed "post-traumatic stress injury"?

And — before you click — can you see the point of the name change?

55 comments:

pellehDin said...: Torts. I smell an "intentional infliction of PTSI" lawsuit just around the corner.; 5/7/12, 11:04 AM
Eric the Fruit Bat said...: Shell shock let a man retain some dignity.; 5/7/12, 11:07 AM
Molly said...: It qualifies the individual for SS disability, or other disability insurance payments?; 5/7/12, 11:09 AM
ndspinelli said...: It is an injury and PTSD has been a damage in civil suits for some time. The plaintiff needs to document how the PTSD has adversely affected their life, but I don't see the name change being that significant. It is a very real thing you know. Is it abused in civil litigation? Well, everything is abused by ambulance chasers. That should not change the fact that legit PTSD is an injury; 5/7/12, 11:10 AM
lemondog said...: A 'd' word:

Disorder
Disabled
Demented
Depressive; 5/7/12, 11:19 AM
Anonymous said...: This comment has been removed by the author.; 5/7/12, 11:20 AM
C R Krieger said...: The stigma of having a disorder, which gets in the way of moving forward, on the job, at home, in life.

We had our Sixth Homelessness Conference up here in Lowell and it was dedicated to homeless veterans. One of the points was that we should talk to Post Traumatic Stress and leave it at that.

I didn't click through. I have my prejudice on this and it is about ending the stigma.

Regards — Cliff; 5/7/12, 11:21 AM
Anonymous said...: Yes, I can see the point of the name change, because more and more PTSD is being attributed to CHI and high suicide rates in veterans.

We discussed this a couple weeks ago, when a few commenters disputed this phenomenon, despite the evidence that I linked to.

I haven't read the link yet as you requested.; 5/7/12, 11:22 AM
Anonymous said...: A record number of people have qualified for disability SS under the Obama administration (just like the record number on food stamps). The VA will be flooded with claims and will not be able to separate the wheat form the chaff. 'Disability' is now a life-style.; 5/7/12, 11:25 AM
ndspinelli said...: Cliff, Thanks for your comment. I see too many PTSD homeless vets in San Diego. They have access to quality care in SD. And, the police have a unit specifically for homeless. If I were homeless SD is the place to be. I talk w/ a lot of these guys and you are absolutely correct about the stigma.

And Cliff, I've been to Lowell and even you would have to admit you would rather be in San Diego!; 5/7/12, 11:27 AM
traditionalguy said...: One of my admired Civil war Generals went crazy from seeing the chaos and the high level of slaughter in the Civil War's first year, and he was relieved of duty. He had refused to sugar coat things in the press interviews, and was deemed crazy.

But with the help of friends he recovered and got his job back and did it rather well despite his hatred of press.

One of his famous quotes was, " Grant stood by me when I was crazy, and I stood by him when he was drunk. And now we always stand by each other."; 5/7/12, 11:29 AM
Anonymous said...: These veterans deserve our support and help. My sister is also a nurse she has worked at a VA hospital for many years and has seen what the concussion blast injuries do to these young guys. Not only do they affect the brain, other vital organs are affected and do disable.

Wars have a strange tendency to injure and maim.

We OWE these veterans more respect than to assume they will be running en mass to claim disability.; 5/7/12, 11:32 AM
Carol said...: 'Disability' is now a life-style.

It must be, because I'm having so much trouble getting a doc to look at my back. I'm dyin, can't function, yet I have to "apply" for god's sake.

It must be because of all the disability & work comp claims, but I could retire now if I wanted, for crying out loud.; 5/7/12, 11:36 AM
Seeing Red said...: There are no more STDs. They are STIs.; 5/7/12, 11:36 AM
Carol said...: Oh, this is about the changes to the DSM.

That whole thing is a joke.; 5/7/12, 11:39 AM
Anonymous said...: Blogger Carol said...

'Disability' is now a life-style.

It must be, because I'm having so much trouble getting a doc to look at my back. I'm dyin, can't function, yet I have to "apply" for god's sake.

__________________________________

You haven't seen the 'right' doctor or the 'right' lawyer yet.
If you see the 'right' lawyer he can get you in to see the 'doctor'.; 5/7/12, 11:39 AM
traditionalguy said...: Life has traumatic stresses built in. Parents die, children die, accidents and disabilities happen.

The intentional infliction of these on men and women should be recognized when caused by an enemy. So by all means let's call the injuries.

I've been listening to an audiobook called "The End: Defiance and Destruction of Hitler's Germany," by Ian Kershaw.

The intentional infliction of distress on Germans by Hitler and the Nazis compounded by the Russians, and by the cruelty of mass British and American bombings of civilians is beyond comprehension. It was amounted to a National suicide.; 5/7/12, 11:46 AM
The Drill SGT said...: speaking as a combat vet who had some level of PTSD (but who grew out of it w/o treatment), I welcome the change. mental illness versus an injury like shrapnel? no contest.

What did I have as manifestations?

- instant reactions to loud noises.
- wariness of strangers and their motives
- combat dreams/nightmares (which is another way of saying that your brain is doing scenario playing andgaming, while you sleep. combat prep) as it were.
- very very light sleeper

all four are survival enhancing behaviors WHILE in combat.

PS: I no longer drop to the ground at the sound of sharp explosions (vets know the difference conveyed by my use of sharp), nor do I have nightmares. at least not combat ones.

PPS: and no, though I love computer gaming, I have never played an FPS. Nor gone hunting since back :); 5/7/12, 11:46 AM
jjones said...: My son, recently medically retired from the Army as a major in the Infantry, served one tour in Iraq and two in Afghanistan. The last being cut short when he was blown up by an IED. He was far luckier than the two soldiers in the vehicle with him who were killed. He escaped with a broken back and other miscellaneous injuries. In the extensive medical work-ups required he was practically begged to declare himself "traumatized".
The medical attention he received, extensive spinal surgery and also psychiatric counseling was great. But the fact is that waving money and excuses in front of vulnerable people is not right. It diminishes those who are truly suffering and exploits those who would be able to succeed on their own.

In reality all combat soldiers suffer from "traumatic" stress. This has been true from time immemorial. My son, while recovering nicely, thank God, is not the same boy that joined the Army in 2001. He is a hardened, somewhat cynical man. He has seen and participated in things that I can hardly imagine and that he is reluctant to discuss. It saddens him when he went to the VA hospital to see men his age (31) wandering around spending their time trying to figure out what they can get instead of being proud of their service and carrying on.
I do not mean to suggest that there aren't cases of soldiers with severe psychological damage. They need all the resources we can muster, but victimization never helped anyone.; 5/7/12, 11:49 AM
ndspinelli said...: Drill Sgt., have you heard of EMDR? It is an approved VA therapy and works very well for many people, but not all. I'm not a vet but had PTSD from a shooting incident. It worked very well for me. The therapist who treated me has treated vets to varying degrees of success.; 5/7/12, 11:55 AM
Joe said...: How about both. I think it entirely possible that some people are more prone to have strong negative reaction to traumatic stress, thus they do have a disorder, but what they actually experience is an injury.; 5/7/12, 11:58 AM
Bryan C said...: An injury is acute. A disorder is chronic and ongoing. One does not imply the other. I think that distinction is important enough to keep.

Lots of people suffer from PTSD who've never been in combat. If there is a stigma around PTSD in the military then I expect the reasons go far deeper than the use of the word "disorder".; 5/7/12, 12:04 PM
Michael said...: I think "injury" is more accurate. Better still would be "Post Combat Injury" eliminating the "stress" concept which I think detracts from the seriousness of the injury. Syndrome and Disorder are equally weasely.; 5/7/12, 12:12 PM
Michael K said...: PTSD is like ADD. It is all in the eye of the beholder. The data will be manipulated just like the autism data,.; 5/7/12, 12:30 PM
Mary Beth said...: Wouldn't it be harder to prove if it's called an injury? It seems as though you would need to determine a specific outside force that caused it while a disorder could be diagnosed from self-reported symptoms without any specific single cause.; 5/7/12, 12:32 PM
wyo sis said...: It sounds to me like it has importance to doctors and lawyers, but only in deciding who has to pay for what. People will always try to game the system, but if I, as a taxpayer, have to pay for someone's medical bills, I'd far rather pay for those of a combat veteran. And, I believe we owe it to them because they put their lives on the line to defend us, whether we believe their war was just or not.; 5/7/12, 12:54 PM
SGT Ted said...: I don't know about this one.

To me it is a form of evolutionary response to fighting. Your brain is teaching itself to react faster to dangerous situations.

PTS describes the physical effect and reaction of the brain as it burns new neural pathways learned in the dangerous environment.

It is when you are then placed back into normal civilization where you react to normal situations with abnormal emotional and physical reactions the disorder shows itself. I didn't really start showing bad PTSD signs until about 6 months after the returning from deployment.

I don't consider that an injury, as it is a natural response to unusual conditions. I'll stick with disorder, as it does take a cognitive, conscious effort, oft times along with medication, to help deal with emotional overreactions caused by it. That is really what you are treating.; 5/7/12, 12:55 PM
Astro said...: While I agree that 'Disorder' is the wrong term, I don't see that 'Injury' is any better.
Didn't it used to be called 'Syndrome'? That seemed to fit perfectly. Why not just use that term?; 5/7/12, 12:56 PM
The Drill SGT said...: ndspinelli said...
Drill Sgt., have you heard of EMDR?

Thanks but no thanks. I dont have any issues that need treatment.

like JJones said. Everybody has PTSI, just some more than others. Vietnam was a long time ago. Maybe I should have ridden the VA gravy train, but back from Nam I was back in college and applying for a Regular Army Commission. talking about nightmares would have been counter prductive at that time :)

Yeah, I got the commission and a fellowship to grad school. ful ride and salary.

got the fellowship by effectively neing the top California cadet at summer camp.. It wasnt that hard :)

Have Basic training at Ft Lewis, go off to combat. Come back as a Drill SGT at Ft Lewis. Come back a year later as an ROTC cadet, how tough can Camp be :); 5/7/12, 12:59 PM
SGT Ted said...: I have never encountered anybody in the service who sneered at fellow servicemembers for having PTSD or thinking they were substandard soldiers if they were being treated for it. I am case in point. I was quite open about my PTSD and meds at work and I was put in great positions of trust and responsiblity for the rest of my career until I retired.

The only stigmatizing I've seen comes from the media and assholes like Dr Phil showcasing violent vets as the norm for PTSD reactions.; 5/7/12, 1:05 PM
edutcher said...: Yes, but injury seems to be a pejorative as, being in the military injures you - so you shouldn't go.

I can see the Lefties getting behind this one.

And I will leave it to the vets here to say whether the Army Vice COS is for it political reasons.; 5/7/12, 1:10 PM
Tibore said...: "Should "post-traumatic stress disorder" be renamed "post-traumatic stress injury"?"

What matters is that the psychiatric field either agree to change the name based on the evidence that such a change is medically necessary, or stand put and not change it because the evidence indicates that it's unnecessary. Or in short, for the name change to be justified medically and scientifically.

If the change is for political correctness or some non-medical reason, I'd hope the APA resists with all their ability. But that said, the article indicates that it's a change being proposed within the profession, and for reasons that can be examined and judged. To me, the fact that they're staying true and honest to their process is good enough. Because of that, I have faith that they'll reach an honest, good conclusion. The only requirement I would presume to impose is that they all stay true to the practice of being evidence based. Deviate from that, and they're no longer practicing medicine. Stay with that, and I'll still consider them trustworthy (within the concept of "Trust But Verify", of course... with medical claims, the process of being a rational skeptic - http://en.wikipedia.org/wiki/Scientific_skepticism - is still a good idea).; 5/7/12, 1:14 PM
edutcher said...: Should be "for it for political reasons".; 5/7/12, 1:18 PM
Donna B. said...: What Bryan C. said -- with the caveat that some chronic conditions begin acutely. Concussion blasts and head injuries (closed and open) are certainly examples of that.

That said, it doesn't require an actual injury of that type for symptoms of PTSD (as currently defined) to occur.

While I certainly do not mean to denigrate the Drill Sgt's experiences and am not equating my experience with his in any way -- I experienced very similar symptoms from a close encounter with a small harmless snake.

But that's why there's a stigma attached to PTSD -- it can happen as a result of such mundane events. At least it can if it's "diagnosed" as it is today. There are those who suggest that what both the Drill Sgt and I experienced is not clinically significant (ie, it didn't ruin our lives and we got over it without treatment), therefore unworthy of the diagnosis PTSD.

http://www.wired.com/wiredscience/tag/ptsd/

So I would definitely like to see PTSD classified in some way that notes the acute event(s) that trigger it. However, I have no reason to believe the writers of the DSM are capable of doing this in an intelligent, reasonable way.

Where physical injury also occurs, I think it's likely that the "PTSD" that might result could be of a different nature and I am certain that it's more complicated.; 5/7/12, 1:49 PM
Anga2010 said...: YAY! And we can change "malaria" to "ague" and everyone will feel so much better.
How about naming every type of sickness "malaise" so that no one gets upset?; 5/7/12, 2:24 PM
sakredkow said...: This comment has been removed by the author.; 5/7/12, 2:34 PM
Carol said...: I detest the assumption that all vets coming back from the Big Sand Box are messed up mentally..some are, some aren't. It infantilizes them.; 5/7/12, 2:48 PM
jimf said...: Under the ADAAA, it would clearly be an injury...; 5/7/12, 2:48 PM
Aridog said...: As a vet from the same conflagration, I think "The Drill SGT" has nailed it. PTSD can result from otherwise normal reactions to stress. It can also be from intense or explosive trauma (which is "injury," no need to be redundant).

I wonder how many other vets, like me, like The Drill SGT, also quit hunting upon return? Not sure what that says about me or any of us that did so. Don't care either.; 5/7/12, 2:53 PM
TMink said...: Drill Sgt, I am assuming you were in Viet Nam, a big assumption, but if so, do you feel comfortable eating at Asian restaurants?

And sorry about the PTSD, I am glad you are better. Thank you for protecting us pal.

Trey; 5/7/12, 3:07 PM
TMink said...: Tibore wrote: "Or in short, for the name change to be justified medically and scientifically."

If only that were so. The American Psychological Association has no been much concerned with science for at least a decade. They awarded a lifetime achievement award to a former president who lost her license due to having a sexual relationship with a patient. Tip or the iceberg. I have not paid my dues to them in about 10 years.

Trey; 5/7/12, 3:09 PM
Roger J. said...: A very interesting thread--Like Drill Sgt, I did spend time in Viet Nam--I have never suffered from after effects as far as I know, and yes, I continue to hunt.

Combat is a brutal experience and I can only believe it effects men in different ways. To this day, I always have a mass said for the troopers I lost in viet nam. They were my brothers.

I dont know where I am going with this, except to say, that men, subjected to brutalizing experiences will react in differnt ways. I only trust the support structures will be there for them.; 5/7/12, 3:16 PM
C R Krieger said...: N D Spinelli

I have to chose my words carefully here, but just let me say that I am never going to San Diego again, for fear I won't return.

My family lived in Long Beach after leaving the East Coast. My Dad's dream job, in the San Diego Shipyard, never opened up, so he took the same job at LBNS.

Regards — Cliff; 5/7/12, 3:19 PM
lemondog said...: How about 'syndrome' or just PTS?; 5/7/12, 3:34 PM
Aridog said...: Roger J ... you continued to hunt just as the majority of my contemporary vets did, too.

Actually, The Drill SGT is one of the few I've heard that reacted as I did and just stopped hunting. No agenda, just stopped, that's all.

In my case it was not and is not an anti-hunting attitude (so long as the hunter eats what he hunts), just a loss of the desire to shoot things. I've worked in slaughter houses so it isn't squeamishness AFAIK. I still maintain firearm proficiency, and belong to two ranges with annual memberships.

I do know a couple PTSD vets who have verified claims and status. They a great folks, creative and capable people. That have one common characteristic, and that is a pronounced difficulty in focusing on a task for extended periods of time. A feature of this seems, to me anyway, to be an opposing increased almost laser like focus when under new stress ...e.g., better in crisis than every day. Heck, I find that somewhat true about me as well, better in crisis mode. Things seem clearer. Whatever.

One of best friends ever is one of the PSTD guys. We've not traded war stories much if at all for over 30+ years now, but I do know he reflects on killing as something "you can't take back" ...that reality is just how it is in his consciousness. He's a big ole USMC guy who I'd trust at my back any day, forever. Typical Marine, too ... when we're in the wilds of the rockies, I occasionally have to suggest to him that a rope or two might be useful in clambering around steep ledges. Nah, he says that's for Army brats ... like me.; 5/7/12, 3:40 PM
Traditional Tibby said...: I fully feel that changing the phrase is political gaming. And I read the comments here with interest. I'm married (37 years)to a Vietnam vet that was diagnosed just 4 years ago with PTSD. The diagnosis has been a life (and marriage) saver. He managed to keep it together for about 28 years. Then he fell apart. Six years ago I was mentally and emotionally exhausted, and ready to give up an walk away, because I couldn't do anything to help him. (I know he was too). Luckily, an old high school classmate reconnected and steered him to the VA. I am firmly convinced that if that had not happened, Mike would be one of the homeless men you pass on the street. Thankfully, he also knew he was falling apart, and is happy to medicate and accept therapy, he wants to be normal, but knows he can't be on his own. I get real touchy real fast about this subject. I feel a lot of guilt over it too. I knew he needed help, just didn't know how, or where to find it. And yes, sometimes it galls me that we're accepting "government help" - but then I have to remind myself of what he did, and what he carried around silently for so many years. And I know it isn't "help", but due.
Thanks for letting me vent.; 5/7/12, 3:59 PM
lemondog said...: Just reading about WW2 vets who decades later are beginning to exhibit PTSD

2009 article
Post-traumatic stress disorder hitting World War II vets; 5/7/12, 4:25 PM
Lucien said...: Straightforwardly, the idea of PTSD is that:1)an individual undergoes one or more incidents of traumatic stress (doesn't have to be combat); 2) later (hence "post") the individual suffers from some constellation of symptoms meeting the diaganostic criteria established by the APA; and 3) these symptoms are not the typical or normal result of experiencing the trauma (hence, "disorder").

But just because one doesn't react to the traumatic stress in a way that qualifies as a disorder, that doesn't mean that the stress and its aftermath, are not unpleasant (perhaps extremely so), it just means that reactions below the threshhold of a pTSd diagnosis are essentially normal reactions.

By analogy, it is normal to be very sad and soewhat depressed after the death of a family member, and this has traditionally been called "uncomplicated breavement" -- not a disorder. On the other hand, some people react in abnormally pathological ways to the death of a familiy member, and do suffer a resulting mental disorder.

It's a worthwhile distinction to make, and one that should not be smoothed over just to avoid "stigma". The solution is to stop stigmatizing mental disorders. Euphemisms will not solve problems.; 5/7/12, 4:36 PM
Eric said...: The military certainly recognizes PTSD as an injury, and has been doing a lot of work trying to figure out how to prevent it, detect it early, and treat it.

Army research suggests for soldiers, anyway, the length of time in theater without a break makes a big difference. I read somewhere for this reason they were planning to shorten tours in A-stan, so you would be in for fewer months and out for at least double that time, but I don't know if they ever went through with it.

Makes you wonder how any of the WW II "for the duration" guys came back sane.; 5/7/12, 4:58 PM
The Drill SGT said...: TMink said...
Drill Sgt, I am assuming you were in Viet Nam, a big assumption, but if so, do you feel comfortable eating at Asian restaurants?

I love Chinese food, Northern more than Southern. Thai also, I like both for the spice. Japanese can be good. Love rice...

Vietnamese? Not at all :)

Not for the implied racism, but rather, I've seen fish sauce made :)

PS: on the hunting stuff? Birds I would not have an issue with, Stalking deer through the wood? Too much like work.

PPS: I wasn't a pacifist after the war, I was a professional Army officer. I just didnt find hunting to be relaxing....

PPPS: Guns? I respect them very much. I am very careful around guns, be they 9mm or 120mm.; 5/7/12, 6:33 PM
The Drill SGT said...: Eric said...
Makes you wonder how any of the WW II "for the duration" guys came back sane.

Almost all had far fewer days of combat than today's Vet.

D-Day to VE-Day was 333 days or so, so most of the troops on the French front spent under 300 days, most of that in a pursuit, which is fairly low stress....

Today's Army Vet, potentially upwards of 1000 days in theater...

PS: 8th Air Force? The Bomber force had higher loss rates than the infantry, but 35 missions was the max standard. You could do that in 4-5 months and have hot meals and clean sheets.

PPS North Atlantic Convoys? very stressful...; 5/7/12, 6:41 PM
harrogate said...: That reminds me of another great thing about Romney. He knows the secret for avoiding the problem altogether. Neither injury nor disorder for some!; 5/7/12, 6:52 PM
Tibore said...: "TMink said...

If only that were so. The American Psychological Association has no been much concerned with science for at least a decade. They awarded a lifetime achievement award to a former president who lost her license due to having a sexual relationship with a patient. Tip or the iceberg. I have not paid my dues to them in about 10 years.

Trey"

I'll agree with you on that. But if you click on the link the Professor gave, you'll note that I'm actually referring to the American Psychiatric Association. Which makes it a subdiscipline in the field of medicine and, I'd hazard, a more evidence-based profession that's hopefully far more rigorous than psychology.

Yes, I know what you mean by psychologists not being much concerned with science. I have a friend who several years out of college actually was in academia designing experiments and once expressed misgivings to me at the rigor and methodology he saw. But anyway, I'm referring to medical professionals, not pseudomedical ones. If nothing else, from what little I've seen (a family friend is a practicing psychiatrist), they're at least more aware of their limitations and at least pay more attention to evidence based practices than non-medical practitioners.; 5/7/12, 6:57 PM
AlanKH said...: I always thought disorder was a type of injury.; 5/8/12, 5:06 AM
AllenS said...: I know a man who I served with in Viet Nam, who was awarded PTSD for having "survivors guilt". That's no shit. With the award and then receiving a full disability check from Social Security (which he told me that got there first), he's making over $4,000 a month. The first check from each was huge. You are awarded the money based on when you filed your claim. It's all tax free. He bought a large farm, and travels around hunting and fishing, drinking large amounts of beer. He feels better.

If you can qualify for PTSD, you'll never have to work again for the rest of your life.; 5/8/12, 7:49 AM