Readers of various journals and websites may have noticed a shift in language concerning what is presently known as Post Traumatic Stress Disorder. There are many who are advocating a change from PTSD to Post Traumatic Stress Injury (PTSI).
The way medical and mental health conditions are described, and the causes we attribute them to changed a lot during the later part of the 20th century. As late as the 1970′s, Down’s Syndrome babies used to be called Mongoloids. In the 1950′s and 60′s, Autism was blamed on bad mothering. (Watch the devastating film Refrigerator Mothers). With the development of science, society has tried to do away with terms that could be construed as pejorative and inaccurate. For instance, what was known for a long time as manic depression was replaced by bipolar affective disorder. Scientists say the term more accurately describes its physical and emotional manifestations.
As others have found, the quest for more accurate and less stigmatizing terminology is a slow one. For instance, to this day, public schools categorize children as “Severely Emotionally Disturbed” to get a higher level of funding for the student whom they are required to provide schooling. It’s not a diagnosis, but a way for the bureaucracy to categorize children to get more funding. Still, the categorization doesn’t really get to the core of the cause, and has a stigma that is long-lasting for both parents and child.
I bring up these examples to illustrate a point: what we call a malady and what we attribute the cause to becomes very personal because at stake is one’s self identity. The person who has been through combat doesn’t want to be characterized as “disordered,” even though their actions and responses may be just that. ”Disorder,” carries with it a heavy weight that sounds permanent. Simlarly, the image an average bystander has of PTSD is more sharply focused on the word “Disorder” than on “Traumatic Stress.” The result can be heavy stereotypes which affect everything from seeking treatment, to how the media depicts veterans.
Last autumn, Army General Peter Chiarelli called for a change from PTSD to PTSI (Injury). The reason –a disorder sounds more organic in cause, like something a person were born with. What they suggest is that PTSD is an injury caused by exposure to combat.
“It is an injury,” Chiarelli said. Calling the condition a “disorder” perpetuates a bias against the mental health illness and “has the connotation of being something that is a pre-existing problem that an individual has” before they came into the Army and “makes the person seem weak,” he added.
On the same page as General Chiarelli is Jonathan Shay, M,D., PhD, who writes in Odysseus in America, Combat Trauma and the Trials of Homecoming on page four:
“…it is evident from the definition that what we are dealing with is an injury: “The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.”
Shay thinks of it as a “psychological injury” rather than a disorder.
But what about the other 90% of the PTSD population, which are civilians, not veterans? Does one group reserve the right to change it for the rest? The term ‘psychological injury’ is applicable to the entire PTSD population of women, children and adolescents –not just veterans. Perhaps to make a change to the diagnosis name, General Chiarelli might need to appeal to a much wider group of advocates. I don’t think the Army can or should proceed alone.
Will PTSI carry less stigma and drive more people to seek help? That remains to be seen. But perhaps the difference is that a disorder seems to be something that is organic and unchanging. To most, the perception of an injury is it’s a temporary state that can be corrected over time and managed with treatment. Does an Injury have more hope than a Disorder? That’s what many are betting on in the quest to get people into treatment.