In a recent Time Magazine article entitled What Is PTSD… And Who Is It For?, psychiatrist Harold Kudler attempts to raise some interesting questions regarding this sensitive and important issue. For example, Is the DSM V for physicians or patients?; Should we call it Post Traumatic Stress Disorder or Post Traumatic Stress Injury? He suggests that the use of the term “injury might help overcome the stigma that many military members and veterans associate with seeking treatment for PTSD…. Service members aren’t happy to report a “disorder,” but might be willing to admit an injury.”
While a consideration of the impact of the term “injury” versus “disorder” on veterans returning from war is a useful one, it falls seriously short of addressing the complexities of the subject. Simply changing a word will not shift the incredible forces that stack up against a soldier’s feeling of safety in admitting to having trouble with the aftermath of war. To begin to deconstruct these forces, consider the following: The practice of making men and women into soldiers/warriors actively discourages tuning in to feeling the human effects of war. This is not a bad idea if you want people to win the battle; it just has side effects.
Additionally, in the last several years the armed services has made it a practice to have soldiers serve multiple tours of duty in relatively short time spans. This creates a cultural understanding/expectation within the armed forces that soldiers should consider it reasonable practice to be sent on multiple tours of duty. The fact of the matter is that this is not a reasonable practice. The violence of war is not good for the physical, psychological and spiritual health of human beings, period. By extension, multiple tours of duty in short time frames can be incredibly detrimental to those who serve. Nevertheless, this is the current practice and the message to the soldier is: You can handle it—you should handle it.
Even if they are willing to admit to experiencing negative outcomes from battle (regardless of the names we use), veterans face an abysmal dearth of services to address their injuries/syndromes/conditions when they return home. As many as 900,000 veteran claims are not attended to for at least one year. What does this state of affairs communicate to soldiers about how they are valued once injured? Furthermore, many soldiers perceive that admitting such problems would hinder their advancement in the military. Changing these factors would have a far greater impact than simply changing the name from “disorder” to “injury.”
Dr. Kudler goes on to discuss a variety of problems in the field of psychiatry that result from the dominant biological bias. The main problem is the reductionist split between mind body and spirit. He states:
Since our focus is human nature, we need to balance our enthusiasm for neuroscience, genomics and other biological studies with a dedication to understanding and treating our patients as people. Our primary goal as psychiatrists can never be accomplished through reductionism or abstraction of any kind: biological, psychological or social.
“It is time to find out if patients are better served by the term PTSD or PTSI,” he concludes.
I applaud Dr. Kudler’s attempt to be more holistic and client centered, but as I stated earlier, the name question only scratches the surface of the problem. Why not work to update the treatment protocols? The current “best practices” most often used for treating PTSD in the military are at least 20 years behind (and much less effective) than some of the state-of-the-art, mind-body methods of psychotherapy available today.
Studies have shown that the current treatment success rate is 49% after 12 sessions. Energy psychology approaches have been shown to be 86% effective after only 6 sessions. If we want soldiers to be more motivated for treatment, why not give them a treatment that works faster and better?
Better yet, why not prevent PTSD/PTSI in the military? One of the main challenges of the DSM is that it is a-theoretical. It simply describes symptom clusters. The drawback of working without a theory is that you cannot really understand the problem you’re trying to address. One of the causative factors of PTSD/PTSI in the military is that soldiers’ bodies become conditioned to “battle mode.” For instance, they are flooded with adrenaline. Their bodies learn to switch on this mode at the earliest provocation. This is a good thing in the theatre of war, but it is very problematic back in main street USA. Energy psychology approaches are low cost, portable and can be self applied…three factors that would make it possible to employ these techniques in the field to help our young warriors prevent their bodies from becoming fixated in battle mode.
More studies need to be done to demonstrate the effectiveness of these techniques in such arenas, but the cost of testing them is infinitesimal compared to the amount of money wasted on even one boondoggle building in Afghanistan; the potential benefit is staggering. What does it communicate that a plan with such a favorable cost/benefit ratio is not being acted upon with all due haste??
Robert Schwarz, PsyD, DCEP is a licensed psychologist, authors of two books on treating trauma and PTSD and is the Executive Director of the non-profit Association for Comprehensive Energy Psychology (ACEP).
 Church,D., Yount, G., Audrey Brooks, A. (2012) Journal of Nervous and Mental, 200(10):891-896