New name for PTSD could mean less stigma

Psychiatrists who oppose the change argue that PTSD has more in common with bipolar or depressive disorder than a bullet wound.

“The concept of injury usually implies a discrete time period. At some point, the bleeding will stop. Sometimes the wound heals quickly, sometimes not,” said Matthew J. Friedman, executive director of the Department of Veterans Affairs National Center for PTSD. A disorder can stretch on for decades.

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Special report: Faces of the Fallen

Although everyone is equally susceptible to a gunshot wound, not everyone exposed to trauma suffers from PTSD. Genetics, military training and even the cohesion in a soldier’s platoon all play a role in determining whether a combat experience results in PTSD or simply a bad memory, experts said.

“The word ‘disorder’ reflects the fact that some people are more vulnerable than others,” said John Oldham, president of the American Psychiatric Association.

Treatment for the malady often includes remembering the traumatic event under controlled conditions until it loses its power.

Origins of PTSD

PTSD made its first appearance in the diagnostic manual’s third edition, which was published in 1980. The doctors who lobbied for its inclusion viewed it as a measure that would finally legitimize the pain and suffering of Vietnam War veterans.

Before the creation of the PTSD diagnosis, Vietnam War-era hawks saw troops suffering from such symptoms as weaker than their World War II-era colleagues. “The view was that they should just suffer in silence,” said Charles Figley, director of Tulane University’s Traumatology Institute. The antiwar doves often portrayed Vietnam War veterans as crazy, deranged and dangerous.

“PTSD was a validation that what the Vietnam veterans were reporting was true, and it connected them to other veterans in other wars and other people who had experienced trauma,” Figley said.

Political fallout

The name-change debate is also being influenced by bureaucratic politics. In 2008, the military considered awarding the Purple Heart to troops suffering from PTSD, but ultimately decided that brain science had not advanced far enough to prove that people were suffering from the condition.

A change to “injury” would make it easier to revise the award criteria, advocates of the name change say.

“To be injured in the service to your country is entirely honorable in the military culture,” said Jonathan Shay, a psychiatrist who specializes in treating the psychic wounds of war and has worked closely with the U.S. military. “To fall ill is not dishonorable, but it is unlucky.”

A shift to “injury” could make it harder for service members to collect permanent-disability payments for their condition from the government, some experts warned. “When you have an injury, you follow a treatment regimen and expect to get better,” Figley said. “This change is about medicine, but it is also about compensation. We are talking about hundreds of millions of dollars.”

Finally, the name change has unearthed other sensitive arguments about the best way to prevent PTSD in the military.

“The whole history of psychiatry is to change the names of conditions. If the problem doesn’t go away, we change the name,” said Bessel van der Kolk, a professor of psychiatry at Boston University. “It makes us feel momentarily better. But it doesn’t change anything.”

If the Army really wanted to protect soldiers, it would limit the number of tours that troops are permitted to do in Afghanistan, van der Kolk said. Medical studies have suggested that a soldier’s resilience is depleted with each battlefield tour. “As long as you have repeated deployments, you will have devastating effects on people,” he said.

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