Dr. Hurd:
Could you explain the truth about Post Traumatic Stress Disorder?
I understand it is predominantly an issue with military men and women coming back from active duty. While I do agree that some people rightfully suffer, I also feel that many are using this to get additional benefits, to bully the household and not take responsibility for their actions. Is the VA too quick to diagnose some of these veterans with this disorder? Let me paint a picture here: The VA diagnoses a person with PTSD and gives him/her benefits and medical. They over-prescribe mood stabilizers and sedatives. Quite often there is alcohol in the mix. Furthermore, these people might have a lot of time on their hands and cannot (or will not) hold down a job. Please advise.
Dr. Hurd’s reply:
Let’s start with the generally accepted definition of PTSD.
‘PTSD is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma.’
Psychological trauma is a subjective term. People can feel traumatized after a war. But they can also feel traumatized after a horrible childhood. Or after not getting a desired job, or getting into the school of one’s choice. People say they feel ‘traumatized’ from sitting in traffic jams.
Trauma is a relative term. Psychiatrists have no interest in making ‘trauma’ an objective rather than a relative concept. I’m not saying it can’t be done, and I’m not suggesting that trauma is not real to the people experiencing it. But it’s important to understand we have no real objective criteria for it.
PTSD gets the ‘disease label’ status of cancer, heart disease or pneumonia. However, there are no concrete and specific ways for proving that one is undergoing trauma, other than through subjective reporting and the value judgments, all relative, of one’s own personal experience. There is no blood test or X-ray to isolate or prove the existence of PTSD. One man’s trauma is another person’s everyday life. Yet according to psychiatry as we know it, it’s all trauma.
In American society, pretty much everything is trauma. Our government and our highly educated intellectuals (psychiatrists included) have turned us all into a bunch of babies. It hasn’t worked with all, but it has worked with many. Doctors and politicians, in many cases, appeal to the worst and the weakest within us. This has had the effect of trivializing the concept of trauma by turning everything into a disaster, an emergency, a catastrophe or a disease.
Cancer and ALS and heart failure are terrible and tragic diseases. But according to the faux wisdom of our times, ‘road rage,’ short attention spans and not making as much money as your neighbor are no less diseases. Once everything becomes a trauma or disease, life is pretty meaningless and you end up with a society of depressed and demoralized people.
In plain English, when we speak of trauma, we’re talking about a persisting, continuing reaction to a painful or upsetting experience. The mind, and even the body, are not handling that stress well. It’s not considered polite to put it this way. This is not necessarily a value judgment about the person. It’s simply a statement of fact, referring to the difficulty a person experiences after a prolonged series of stressful events.
The notion of trauma should never have been medicalized. Trauma is not a medical or physical disease arising out of biological factors. Trauma is a state of mind, a way of reacting to particular events, not a disease caused by infection or genetics.
This is the broader problem with psychiatry as we know it. The field adopted the ‘medical model’ initially as a metaphor for disease. Now people treat psychological syndromes and emotional states as equivalent to diseases. Got trauma? We say ‘PTSD’ instead. It’s not necessarily as accurate to call trauma a disease, but it works out well from the point of view of meeting the requirements of our fawning and politically correct society, not to mention making it all billable to third party government programs.
It’s true that emotional problems sometimes manifest as physical symptoms. For example, people with PTSD can experience problems with sleeping, breathing or racing heart. Even so, we don’t always know for certain that this is due to the trauma. Different people have different temperaments. There are anxious and emotional people, and there are less anxious and less emotional people. You can place a highly anxious person in a traumatic event, such as a war, and a calmer person, and they’ll come out of the experience in different emotional shape. We can’t apply a one-size-fits-all scenario, such as a disease progression model, to the huge number of variables that will affect one person one way, and a different person a different way.
Originally, PTSD applied only to extreme situations, such as war or unusual and horrible events such as fire or disaster. Given the subjectivity of the diagnosis label, it was only a matter of time before psychotherapists and psychiatrists began to apply it to just about anything a particular individual finds uncomfortable. For example, there’s ‘non combat PTSD’ and PTSD following years in an abusive childhood.
While it’s unhealthy to ignore or minimize the effect of a genuine trauma, it’s equally unhealthy to make the past experience of trauma the defining characteristic of the person. It saddens and angers me to think of people approaching a psychiatrist or therapist for help saying, ‘I want to move past the trauma,’ and being told by the professional, in effect, ‘The trauma is who you are.’
Mental health professionals and physicians who label their patients “PTSD” are telling these patients that their misery, their misfortune and their tragedies define who they are. They elevate the tragic and the sadistic to the most important aspects of life. They would never try to motivate themselves this way, but they impose this form of destructive self-labeling on the already beleaguered person they claim to treat. Health professionals might not be conscious enough, or even smart enough, to recognize this is what they’re doing. But it’s what they’re doing.
I don’t know for certain whether officials and health professionals in the VA are over-prescribing medication or giving out benefits too easily. I do know that the nature of the welfare state, for veterans as well as anyone else, is to foster and maintain dependence on the government. The government and the psychiatric field are well suited for each other, in this respect. We actually do need a military, but the incompetent elected people who lead our government tend to use that military for their own advancement of power, not for national security. If you ask me, this is the real victimization that members of the military experience, the fact that they’re put in harm’s way (most of the time) for no real reason.