Will re-naming Post Traumatic-Stress Disorder (PTSD) to Post-Traumatic Stress Injury (PTSI) help to reduce patient stigma?According to Matthew Friedman, MD, PhD, the answer is no.
In our last post, I talked about whether or not we should drop the “disorder” from PTSD. Now, let’s get into the discussion the American Psychiatric Association is having.
In 2011, then-Army Vice Chief of Staff Peter Chiarelli made a motion to the American Psychiatric Association asking them to modify the name of Post Traumatic Stress Disorder.
Chiarelli claimed that labeling the condition as a “disorder” creates the stigma that there is something wrong with the soldier as an individual, and acts as an obstacle by preventing them from getting the care they need.
Dr. Friedman, however, believes that simply changing the name without changing anything else would not accomplish anything. He suggests that we instead shift our focus to how the U.S. military handles soldiers who have been traumatized.
As an example, he highlights the fact that the Pentagon does not consider solders with PTSD for the Purple Heart, an unfortunate occurrence that he considers more damaging than the name itself could ever be.
Alternatively, Friedman suggested that following the Canadian model for treating veterans suffering from psychological trauma may be a better solution. He argues that the Canadian model exhibits successful approaches in helping military personnel to “acknowledge their PTSD, [and] to reduce stigma for seeking help.”
The Canadian military coined the term OSI or “Operational Stress Injury,” which pertains to a range of persistent psychological difficulties resulting from service, including PTSD. They also funded counseling centers for veterans and started an education campaign to raise awareness about mental health.
There was one facet of the Canadian plan that I found particularly touching – they consider soldiers with OSI eligible for the Sacrifice Award, the equivalent of the U.S. Purple Heart.
Friedman believes that the Canadian model is “brilliant” because it allows us to have it both ways; in his mind, the stigma is addressed effectively without altering the diagnostic label itself.
Chiarelli countered by pointing out that the Canadian military was forced to invent the term “Operational Stress Injury” because it accepts the guidelines of the American Psychological Association.
Because the new Canadian term only extends to troops, it may be confusing and damaging to soldiers after they leave the military. Chiarelli described a hypothetical example of this issue as, “I left the Army and it was Operational Stress Injury, but now I’m a veteran and it’s Post-Traumatic Stress Disorder?”
Is the Canadian model the next step for how the U.S. military deals with PTSD?
Would you like to learn more about how to overcome treatment barriers with combat veterans?
NICABM is offering a comprehensive training program, the Rethinking Trauma webinar series, which will cover treatments for soldiers as well as the newest mind-body approaches to healing trauma.
Have you had patients who viewed the labeling of PTSD as a stigma discouraging them from seeking treatment? Please leave a comment below.
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Mentally injured servicemembers need our help. Right now, in the United States (U.S.) thousands of mentally injured servicemembers have been denied “Veteran” status and access to mental health support services needed to effectively transition out of the military and reintegrate back into civilian society.
I think we can all agree that we want to see our social community (mothers, fathers, brothers, sisters, friends, neighbors, and community leaders) join together and demand that elected National policymakers address this problem now; because, we owe it to all servicemembers who have been mentally injured fighting wars across the globe.
We will need to join together (fathers, mothers, brothers, sisters, and friends) and reach out to our elected leaders demanding action on behalf of our communities.
It is time to correct this social wrong.
I am grateful to live in a nation that benefits from the selfless sacrifice of thousands of brave men and women and I want to ensure that our injured brothers and sisters who have borne the Nation’s battles receive the medical services needed to fight and win the battle against mental injury.
I don’t think I am alone . . . we need to unite and demand effective mental health care for our injured servicemembers.
I too am a Canadian Vet with, according to the DSM, PTSD. I may not have been forced into this diagnostic shoebox if the psychological component of my physical injury had been treated prophylactically, as part and parcel of the physical injuries I had been treated for. The recognition and treatment of PTSD’s early warning “bundled” symptoms as OSIs and treating them in their infancy is , to me, the key. Kind of like treating a cold BEFORE it becomes pneumonia. If there is a threat of a neck injury, we immobilize and protect to PREVENT permanent damage. Why not a similar approach here?
Why not treat a potential psychological injury with similar caution and foresight? First aid saves lives.
I am a canadian veteran. I experienced discrimination and racism. I developed ptsd as a result and was awarded benefits. I never went to war. Why am I excluded from receiving the sacrifice medal? the threat I felt was real to me at the time and my ptsd is a wound for life. I lived in an hostile environment. There were no bullets flying but the threat was real and it impacted me and I was transitioned out of the service. It happened while I was serving my country. All service people that have ptsd should get the sacrifice medal especially those that are alive. I lived through a war of racism, neglect and given shit jobs because I was targeted. I refused to quit so I was forced to quit. I deserve a medal for all that.
With all due respect to Dr. Friedman, I was a study participant when the VA opened up their PTSD studies to “Non-Veterans”. If the Canadian Forces “OSI” (Injury) is applicable to Combat Veterans, what term would best serve the Chowchilla Schoolchildren, Rwandan Genocide survivors, Domestic Violence/Sexual Assault Survivors, Halocaust Survivors, Industrial Accident Survivors, Bhopal Survivors, Fukushima Survivors, CDC/Kaiser-Permanente ACE study participants with scores over 4, Canadian Aboriginal School survivors, Achilles, Audie Murphy, Witch Burning witnesses, Sioux City Iowa first responders, 9-1-1 operators who don’t get debriefed/clinical supervision, African Americans whose relatives were lynched or had dogs “sicked” on them by police, Rom concentration camp surivivors, Medical Malpractice survivors, ….. (please forgive any unintended oversight/omission of others deserving of our compassion) ?????
As a Vietnam Hospital Corpsman combat veteran with the Marines flying medivac, I AM NOT DISORDERED. I have been on a long journey with PTSD and get real tired of all the academic types throwing labels all over. Very few therapists, of all persuasion, have ever experienced combat or have smelled mass death or placed their hands in the goo that was once their buddy. Therapists always seem to have some academic detachment. Combat stress is a normal reaction to a horrific event. There are many complimentary therapies that work. There are medications that can help in the short run. There are theories that may apply. Each person who has experienced trauma must find what fits for them. I have used guided imagery as well as EFT but the real answers and help came when people would just listen, on a soulful level, to my story. When people understand that combat creates a soul and moral wound perhaps more in depth healing can take place. Learn from history on how ancient cultures as well as our Native Americans dealt with Warriors – THEY DEEPLY LISTENED TO THE WARRIOR
AL, I know your pain and fight all too well. I was a combat medic in our most recent wars and thought I was “fine” upon returning. I had physical injuries but was confident I didn’t have PTSD. For most, the progression of PTSD’s changes on the mind and soul/personality is a slow, creeping, insidious invasion. It can silently pull at the threads in your personal and professional relationships and impact your judgment in subtle ways. The patient often can’t recognize the impact until it has become critical. At that point the entire thing is overwhelming and those with PTSD have great difficulty in figuring out how to move forward. Many will recover while others will end up with PTSI, which is generally accepted to mean those who experience PTSD without relief for the long haul. That outlook is crushing and I doubt many others could relate to the implication that you will spend the rest of your life under the constant thumb of PTSD symptoms. Still, I am hopeful that the new therapies being developed will show a brighter future for us. For now, just know you aren’t alone and understand that I hear and see you.
Forget the politics and niceties. PTSD is, in fact, an “injury.” It not only has emotional and chemical impacts on the brain, it causes visible changes to key parts of the brain that can be seen in scans.
Calling it an “injury” has nothing to do with making it more palatable — it’s bringing it in line with medical science!
If we consider deleting”disorder” regarding PTSD, we might also want to delete it with respect to the general classification of Anxiety Disorder which seems severe.
would Traumatic Hyper Arousal Ccomplex Ie THAC be more easily understood both for the client and the therapists at the same time taking away the stigma ansd psychological fear and pain ?
PTSD in my opinion is derived from Shell shock. Symptoms suffered by soldiers returning from the second world war. Only later it became clear, that civilian sometimes suffered similar symptoms and was the term PTSD extended to civilians with trauma. It seems to me a sort of falsification of history to now change the term. Which by now has become recognized worldwide. Possibly some soldiers suffer from symptoms temporarily and then a term like operational stress disorder might be more appropiate. What is wrong with the word disorder. A person suffering from PTSD knows clearly things are not quite right in one’s brain. I loved Jeffrey Schwartz, it was, i think, who educated all his clients/patients, that they were never their disorder.
How the US treats veterans with PTSD is unbecoming.
I understood they recently discovered a gene, which apparently explains why some people/civilians experience wartrauma’s and some do not. Possibly that may also be the case with veterans, or others that went through trauma.
Thank you Ruth for addressing BOTH sides of this issue!!!
I would like to challenge the accuracy of this so called injury. using the neuroscience of Rick Hanson, trauma is stored in the amygdala at the time of our abuse with the abilities of the person at this moment.
A child with have the capabilities of a child. The amygdala is working fine in fact it is beyond perfect. A conscious or unconscious trigger alerts and the amygdala fires our fight or flight mechanism. The adrenal stress response is fired. what is injured. Working fine.
I am healed and have the same trigger thoughts and fears today. My amygdala must be empty now. The thoughts are just air, so thoughts can not be injured.
We have a serious disorder that has stolen the switch to our defense mechanism. No injury.
In fact I I’ll tell you that having complex childhood PTSD has made me an expert on the adrenal stress response, on cortisol and fear. We can learn that fear is only a warning system and trigger thoughts are delusional. Nothing is broken, I fixed nothing.
We all have every emotion so why let an emotions describe our identity. This is not injured either. it is just a matter of where you direct your attention. If you select to focus your whole being on a few scary triggers, life shrinks. These small thoughts become your life.
Special forces actually trains its soldiers to be able to act when fear is present. We can do this also with the breath. Rick Hanson says we have one with a million zeroes behind it as opportunity and the cellular level. Why limit yourself.
I am for normalizing stress and overwhelming stress (PTS) as this is one of the best ways to begin the healing. Not only are the symptoms of PTS a normal occurrence if we have been overwhelmed, the symptoms are for the most part in the nervous system and show up as physiological symptoms, not all emotional or psychological. Perhaps some of the discussion could be why it needs to be in the DSM at all, when the long-term affects of PTS are physiological: IBS, Fibromyalgia, High Blood Pressure, Hypertension, Migraines, Sleep issues (which complicate a great deal).
I applaud the Canadians. I also think that educating our first responders and soldiers ahead of time what trauma is and that it is normal, and it can be healed and how would be a preventive measure in reducing the stigma. Prevention and early intervention is what I vote for.
As a person today recovered/healing from complex, long-standing pts, I am deeply grateful to see this discussion occurring. The Blue Star Families 2012 Military Family Lifestyle Survey Report which was recently published notes that: “More than 60 percent of troops who believe they have post-traumatic stress are not seeking treatment through the military, according to spouses surveyed in a recently released report. The nonprofit Blue Star Families found that only 35 percent of servicemembers displaying symptoms of PTS sought military medical treatment,” while others “sought civilian treatment or ignored their symptoms.”
Thankyou once again Ruth and Belleruth, et al!
My apologies for the quote a bit out of sync…this info is from the 21 May 2012 Military Report at military.com. The article is titled: Troops not seeking help” and there are links in the article to the Blue Star report. We have many Blue Star and Gold Star Mom’s in our community and know they are sending their heart appreciation and thankyous as well!
Good day to all and thank you for mentioning us Canadians! I was in the Canadian Armed Forces and I now work (as a civilian) with Canadian military members. I just want to clarify how the term “OSI” is being used. Although it includes PTSD, it is not meant to replace this term because it encompasses any mental health related condition which may be caused, triggered or exacerbated by exposure to unique military stressors. As well, use of the term “Operational Stress Injury” is not a clinical diagnostic label. It is more of a tool to reduce stigma and suggest “recovery.” (Disorder sounds permanaent to many.) This term is also used in conjunction with a Mental Health Continuum Model which outlines progressively escalating stages ranging from health, to reacting, to injured, to ill. If seen in such a way, (rather than simply healthy or ill) there seems to be less stigma & perhaps more importantly, more hope that one can be successful in shifting back to the health side of the continuum. I hope that this helps clarify how the term OSI is being used.
Hi Ruth: I was finally diagnozed in 2005 with PTSD and it finally gave a name to all the messes I had made in my life all the wrong choices etc. There was finally a reason and something I could work on changing. I was in therapy for 5 years with a group of therapists that worked with women who had been sexually abused as children I also started seeing a psychiatrist in 2003 as I had injured myself in an accident and started to be depressed from the chronic pain. this Doctor refused to give me the PTSD diagnoses as he said it was just a matter of schemantics. I finally stopped seeing him in 2008 because I didn’t feel he was helping me. The word disorder didn’t bother me as I thought that a disorder could be fixed and it was. Mental Illness still has a stigma with the general public and until more awareness is given to it just being an illness the same as diabeties etc. would be classified as an illness nothing will change. Thank you, Kathy
What has been focused on too little in trauma therapy is recognition/acknowledgment of the client’s personal reality–that the feeling is real: as real as it can be, i.e. neurologically and physically real. It would be compassionate to recognize that pain, even though it makes no logical sense in present day, it hurts and is uncontrollable when it loops.
Until the looping is released, all the behavioral therapy in the world has next to no efficacy. How can this be tested?
I believe educating our culture about PTSD is as important as dealing with the stigma. The two are directly related.
I have go to work but I could not pass up this discussiion. DSM from it’s outset is a very political hot potato. Traumatized Veterans and the general population are subcatorized into subcatagoized into on nausium so the white coats can get paid and prescribe drugs. Whoever is chairing the commitee and the parties of the commitee are acting like gods in deciding who is going to be treated on not. Cannot wait to see what DSM V leaves out.
For the past 40 years or so when my two younger Brothers returned from Vietnam, all I have seen or heard from the medical profession is how to describe mental trauma caused by war, rape, accident, ets.. When a person feels the effects of some event that causes that person to be traumatized AFTER the event, IT IS POST TRAUMATIC STESS. You can call it PTSD, OSI, or Brain fart, it is still mental trauma. Instead of looking at a compromise of possible stress reducers, the people with the letters are more interested in publishing a paper and get their name out to obtain another grant than curing anything. An interesting point to note here is Dr.Gyldensted being from Denmark can speak openly about another alternative therapy without worring of losing a license to practice by suggesting TFT/EFT as an alternative therapy for mental trauma. Let me make a suggestion for all those sceptics out there. We all know Cognitive Behavior Therapy, Talk Therapy or drugs have done very little in eliminating mental stress for anyone. Those Psychologists and Psychiatrists who use TFT/EFT in their pratise have made compromises in proving that enrgy medicine works. Those that are strict CBT followers, it has been shown that using TFT/EFT with CBT therapy the results have improved. Dr. David Feinstein Ph.D has written several papers about TFT and EFT and his most recent paper -‘Accupoint Stimuilation in Treating Psychological Disorders: Evidence of Efficacy’, which will be published in the APA journal points out the problems of those who think the studies and results of TFT/EFT are anecdotal. Sooner or later the FDA, AMA, APA and other organizations will have to come to terms with over 5,000 anecdotal studies since 1982 of curing mental trauma using TFT and EFT, there maybe something to this after all. I believe someone will finally realize that the combination of CBT and TFTor EFT have a place in psychotherapy. Then I will watch the DSM manual shrink to maybe as few as 100 pages. HA!HA! Be Well, Semper Fi, Michael
I would really like to encourage all of you who may be interested in making rapport with vets and support them in their reluctance to treatment to go to eft4vets.com and listen to Ingrid Dinter’s videos ! Her father was a soldier (POW) and she is doing such a heartfelt job with EFT(emotional freedom technique) ! A great ‘psychologist’. Highly recommendable !
All best to all of you ! Bente
Post traumatic Stress affects a great number of people for a great number of reasons. Currently there is a pretty intense focus on veterans of combat due to the fallout form ten plus years of war, which clearly cannot be ignored.
People like Bessel van der Kolk, Judith Herman, John Breier, Allen Schore, Pamela Church, the Stone Center at Wellesley College and others have been studying and writing about the effects of post traumatic stress for many many years ~ without much attention, especially as it relates to early childhood and the longterm consequences of repeated interpersonal/relational rupture, be it emotional, physical, sexual, or some combination thereof.
It is becoming increasingly more important to look at the whole picture and for the medical/mental health profession to start recognizing the actual reality (not just what the DSM IV outlines) of the human condition when faced with certain overwhelming circumstances.
The NAME is less important than helping ALL people gain access to the information that can help them help themselves (or their families and friends) get help without shame.
It’s been long enough ~ now it’s time to get real about this condition that exists in subtle and nuanced layers to varying degrees in most people who have been exposed to extreme stress with little or no support structures in place AT THE TIME of the event/s.
Thank you for listening.
Julia Tupper, CPC
Thank you for recognizing that PTS(D) is not only combat related. Seems people have forgotten that so many others suffer with the malady–not just combat veterans. I think it’s particularly telling that much of the conversation on this website focuses on the military and how to redefine PTS(D) for that population. A more global perspective is needed for most of what is written in the DSM. Let’s be careful not to write/define all others out of the PTS(D) diagnosis: they need our help as well.
In my experience, those who worry about approval or labels do not heal. The military stigma filters down through the ranks not in the name. It is a sign of weakness a vulnerability remains in place.
We must come to grips with the thoughts, those fearful triggers we avoid. Changing disorder to fun times heals nothing. This is a serious battle that many young people are committing suicide instead of seeking help. The word disorder is way overrated then.
We can minimize The incidence of PTSD first. There is a cortisol test at waking and then a half hour later. You can determine if a nervous system is more vulnerable to receiving PTSD. These soldiers are support only then.
Then be proactive, start a mindfulness program. teach soldiers how to activate their parasympathetic nervous system. They will heal themselves with direction from a therapist. teach them how to reduce cortisol and adrenal levels and how to stay present.
We need more action, mental and physical. To heal quickly a daily routine of mindfulness, affirmations and attention to positive self talk can improve an individual quickly. Calm the nervous system first and then start a daily routine.
Developing the ability to direct your attention to the breath calms us and keeps us present. If you can develop a strong focus then you can apply it to trigger responses and integrate trauma to the present.
fear is a warning signal not something to avoid. it is a body mechanism as is our fight or flight mechanism. Why be afraid of yourself. Fear can not hurt you. Example: While walking in the woods a big bear stands up and growls. I am ten feet from him. My fear is reinforced with my adrenal stress mechanism firing. I am more than scared. Then”…….. The bear turns and walks away.
I am harmed physically or mentally. I submit to you not at all. .If you can stay present and observe, empty of thought, you will see trauma fears are not real. past traumas have no power.
Our thoughts have no power. Think about stopping traffic next! PTSD fuels as we dissociate into the past stories or future worries. if you stay present in this moment it can not fuel. Small increments is how we heal. take action now.