The twentieth century was rife with war and catastrophic trauma. Anything lesser suffered during such time was considered trivial, dismissed as the sufferer’s individual weakness, a failing in psychological fortitude.
Enter Post Traumatic Stress Disorder (PTSD), answering the demand to explain Vietnam veteran syndrome, combat stress reaction, concentration camp syndrome, rape trauma syndrome, battered woman syndrome, abused child syndrome and further associated labels.
The PTSD diagnosis was created to meet the need for symptoms arising from catastrophic trauma. Over time, however, the diagnosis seems to have lost its way in addressing this need.
A broken industry
The Diagnostic and Statistical Manual of Mental Disorders (DSM III) cited the PTSD qualifier as: Characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience. The precipitating stressor must not be one which is usually well tolerated by most other members of the cultural group (e.g., death of a loved one, ordinary traffic accident).
The International Classification of Diseases (ICD 10 – Current version) uses what I believe to be the best description still to date: Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.
There are key words in those statements, “outside the range of usual human experience” , “exceptionally threatening or catastrophic nature”, “which is likely to cause pervasive distress in almost anyone.” These are facts often dismissed when trying to explain one’s specific circumstances around complete contextual meaning.
Unfortunately, due to today’s perpetual need to find the next level of political correctness, the diagnosis is increasingly handed out like condolence cards, assigned for every one of life’s bumps and bruises. Worse, this is done by the very people who are meant to work in the best interest of their client and society at large, ensuring to not pathologize society.
While fixing some of the holes created from the DSM 4, which made a mockery of PTSD criterion since the DSM 3, the DSM 5 (current version) still falls foul to this modality of political correctness, allowing society to be pathologized into this neat mental health model after what are, in essence, traumatic events.
No longer do we experience an event, talk about it and move on with our lives. Instead, we have a mental health disorder, are treated as guinea pigs using psychological therapies, then if we do not recover within this statistical timeframe, are guided towards the use of medication for treating this apparent disorder.
Now, let’s not confuse this with legitimate cases where a person is debilitated by symptoms after experiencing horrific trauma.
If you want to call this process scientific evidence — individuals self-reporting symptoms, followed by a psychological professional interpreting said report, mixed with their personality, experience and capacity of emotion, then apply a label based on a group of professionals who prior agreed on a majority statistical model which asserts people presenting a, b and c symptoms have x, y or z diagnoses — then sure, you may convince yourself that mental health has scientific foundation.
Otherwise, the fact is that there is little valid science underlying mental health diagnoses, nor the prescribed medications to treat these fictitious disorders, beyond best guesses gleaned from statistics.
When something is special
What most people don’t understand is that PTSD is special. It is the only diagnosis to contain a required event occur for diagnosis. PTSD diagnosis has a legal component attached to criterion A, being that a trauma professional is legally stating that trauma of significant distress has occurred. This variable impacts disability claims and legal circumstance.
As a result of PTSD’s uniqueness, understandably it has been embroiled in controversy since inception. The only diagnosis close to PTSD’s controversy is Dissociative Identity Disorder (DID), which is the new (politically correct) name for multiple personality disorder.
Today, in the twenty-first century, we have people claiming PTSD for all sorts of events, such as wisdom tooth extraction, obnoxious jokes in the workplace, cheating spouses, relationship breakdowns and women who had uncomplicated births. PTSD is academically a diagnosis reserved for those who meet very specific traumatic criterion and severity. None of the above meet this criterion, yet professionals diagnose based on meeting a categorical symptom profile, loosely surrounding what the individual claims as traumatic to themselves.
This erosion of diagnostic stringency is called criterion creep. In other words, humans slowly broaden the definition of trauma, often self-justifying what they feel is traumatic enough.
Is a tooth extraction, obnoxious joke, uncomplicated birth, cheating partner or relationship breakdown equivalent to rape, torture, violent death, childhood abuse or war? That very question has certainly been met with diverse responses by those here who do meet the traumatic criterion for PTSD diagnosis.
Are the academics of PTSD accurate? Can only those who experience catastrophic events have PTSD? Maybe the most interesting question of this entire discussion is: can the PTSD diagnosis sustain its criterion A traumatic requirement?
The way things are progressing, PTSD’s future is going to get uglier. PTSD is the hip, cool, “in” diagnosis at present. It rolls off of the tongue — post traumatic — meaning anything prior that caused distress must befit this diagnosis! Right? That is very much the way many tend to view the diagnosis.
It’s complicated; that much I know. I believe that reader comments for this article may broaden the opinion base relating to questions posed, but let’s try to further understand what is happening with trauma diagnosis today and where this diagnosis, which is often so central to our lives, might be headed given the current diagnostic climate.
Written by Anthony, who founded MyPTSD in 2005. He is a veteran, writer, and web designer. He lives with his wife and two heinously cute puppies in Melbourne.
Edited by Simon, who earned her writing degree in 2011. She hopes to one day garner a doctorate in composition. You can find her on MyPTSD, where she talks (too much) about her dogs, life, the multiverse, and Everything.