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What’s in a word? Recently, military and government officials are trying to drop “Disorder” from PTSD (post traumatic stress disorder). (washingtonpost)
Who is doing this? The list includes former president George W. Bush, several members of Congress, and former military leaders. But why?
Many believe PTSD is now so negatively stigmatized that we need a new term. Some, like former president Bush think PTSD is mislabeled by calling it a disorder, but if PTSD is not a disorder is it a normal reaction to stress? Does it need treatment? Others from former military leadership think that changing the name will mean more soldiers will seek treatment. “No 19-year-old kid wants to be told he’s got a disorder.” (washingtonpost)
I think this just confuses things. Did changing names of psychiatric conditions from the past lead to lessening of stigma? Stigma arises from ignorance, not from words. Numerous examples of this from the past include what are now considered pejorative terms for many psychiatric disorders. For example, the terms “idiot,” “moron” and “imbecile” originally described simply a specific numerical level of IQ score, then when stigmatized were changed to “mental retardation,” and when that was stigmatized, it was changed now to “developmental disability.”
“Lunatic” was once the term for all patients with a mental illness, and the term was only recently removed from federal legislation by the Obama administration.
So, we certainly need terminology that is not stigmatizing or hurtful, but changing the name is not enough.
PTSD is stigmatized because many don’t understand it or don’t consider it an injury, but instead a personal weakness or character flaw. Some question whether PTSD in combat is a form of cowardice. Can a hero get PTSD? This has been a century’s old problem since the days of shell shock in World War One.
I have written about this in my various textbooks in psychiatry (e.g., Stahl’s Essential Psychopharmacology, 4th edition, 2013, Cambridge University Press) and most recently I even wrote a thriller novel of historical fiction, Shell Shock, hoping to get the story out in a more readable format.
The reality is that the nature of modern warfare has changed such that most soldiers do not die (maybe one in a thousand), nor are they physically injured (about one in a hundred), but survive with a psychiatric injury, from PTSD to depression to eventual suicide (total is up to one in five). In Iraq and Afghanistan there were perhaps 5000 deaths, 50,000 injuries, about a third of which were serious, but 500,000 cases of PTSD. We are also losing 20 to 30 veterans a day to suicide. What we need is a much better understanding that these reactions to combat require early treatment, and new efforts at prevention.
Changing the name will not fix the problem.
Stephen M. Stahl, MD, PhD, a professor of psychiatry at the University of California San Diego, is al an Honorary Fellow at the University of Cambridge.
