In recent years, a debate has been brewing between the U.S. Army, the American Psychiatric Association (APA), and veterans’ and women’s advocates about the pros and cons of the medical term post-traumatic stress disorder, or PTSD.
According to PBS NewsHour, critics say the word “disorder” stigmatizes trauma survivors and prevents them from getting the treatment they need. That’s why some experts, such as pioneering trauma psychiatrist Frank Ochberg, have proposed alternative names that are more “accurate, hopeful, and honorable,” he said.
Here is a primer on the PTSD name debate, with background information on each of the terms.
Post-Traumatic Stress Disorder (PTSD)
History: The phrase post-traumatic stress disorder first appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, although the condition had been documented (via alternate terminology such as shell shock, battle fatigue, and soldier’s heart) since at least World War I, reports the Washington Post.
Consider this: According to PBS NewsHour, the term was devised in an effort to legitimize the suffering of Vietnam veterans, convince insurance companies to pay for treatment, and bring an umbrella of trauma syndromes (including rape trauma syndrome, concentration camp syndrome, and military trauma) under one moniker.
Criticism: Some experts and advocates contend that calling PTSD a "disorder" discourages too many people—especially those in the military—from understanding the condition and getting the treatment they need.
Post-Traumatic Stress (PTS)
History: In October 2011, Iraq veteran and four-star General Peter Chiarelli, then the army vice chief of staff, asked the APA to change the term to post-traumatic stress, or PTS.
Consider this: General Chairelli wanted to drop the word “disorder” because it “has the connotation of being something that [was] a pre-existing problem” and, from the standpoint of military culture, “makes the person seem weak,” he told PBS NewsHour. (He later became an advocate of the term post-traumatic stress injury, see next entry.)
Criticism: Although the term PTS was adopted by some high-ranking officials at the Pentagon, the Washington Post reported, it hasn’t caught on in the medical community because critics were concerned that it doesn’t reflect the full spectrum of the condition’s symptoms and that the toned-down term could jeopardize insurance coverage and federal disability claims.
Post-Traumatic Stress Injury (PTSI)
History: In April 2012, two leading trauma psychiatrists, Frank Ochberg and Jonathan Shay, wrote a letter to the president of the APA requesting that the organization change the diagnostic label to Post-Traumatic Stress Injury (PTSI). The APA was in the process of revising the DSM for the first time in 12 years. Ultimately, the organization decided not to change the term before publishing the fifth edition in 2013.
Consider this: According to the Washington Post, “Those in favor of the new name maintain that PTSD is the only mental illness that must be caused by an outside force.” And psychiatry experts like Ochberg argue that trauma changes the physiology of the brain. “The person is not "disordered," but a brain function is injured. It no longer works the way it used to,” he told PBS NewsHour.
According to some experts and veterans, the word “disorder” has a strong stigma in military culture, while injuries are considered to be inherently honorable—a sacrifice a soldier makes in service of his or her country. The word injury is not only more accurate, they argue, but the term suggests it’s possible to heal, while a disorder can be considered permanent, the Washington Post reported.
Those wanting to change the diagnostic label to PTSI argue it would help the military community mentally reframe the condition in a more positive way and encourage those who are suffering to get the help they need to heal—ideally, with an increased level of support from their commanders and troops.
Ochberg and Shay also started an online petition to change PTSD to PTSI. Prominent women’s advocates, such as Gloria Steinem, mental health experts, veterans’ advocates (such as Chiarelli), and people who have been diagnosed with PTSD have added their endorsements—evidence of just how many people believe in the power of a word to change our perception of a condition, and perhaps, our ability to heal.
The criticism: Trauma expert Bessel van der Kolk says the PTSD name debate is a “waste of people’s energy.” He told PBS NewsHour, “There are so many important things to address that this would be the last order of priority.” He went on to say, “New terms are invented with every generation in order to overcome the stigma of the previous term. So people don’t like psychologically wounded people. Whatever name you give to it, sooner or later it would become a derogatory word.”
Trauma expert Matthew Friedman, who acted as the chairman of APA's committee overseeing the DSM-5 update of the PTSD diagnosis, wasn’t convinced that the “injury model” is backed by science. He also thinks introducing a PTSI subcategory for less severe cases of PTSD would create diagnostic confusion.
Operational Stress Injury (OSI)
History: According to PBS NewsHour, the Canadian military coined the term Operational Stress Injury (OSI) around 2000. The term is intended for the military community; the medical community continues to use the DSM diagnostic label PTSD.
Consider this: The term OSI was intended to help educate Canadian soldiers that the condition is a psychiatric injury they sustained in combat, not unlike a physical wound, reports PBS NewsHour. Notably, soldiers in Canada who have OSI are eligible for the Sacrifice Medal—a military honor equivalent to the Purple Heart. (In the United States, a proposal to make soldiers with PTSD eligible for the Purple Heart was rejected by the Pentagon in 2012.)
Criticism: General Chairelli argues that using two terms in two different circles will create confusion for military service members and veterans. Some PTSI advocates are intrigued by Canada’s approach, but they’d like to take it one step further by convincing the APA to adopt PTSI as the diagnostic label, so that the military and medical communities are using the same terminology.
Post-Traumatic Growth (PTG)
History: According to the New York Times Magazine, the term post-traumatic growth, or PTG, was coined in 1995 by Richard Tedeschi and Lawerence Calhoun, two psychologists at the University of North Carolina, Charlotte. Sometimes referred to as the “positive side” to PTSD, it acknowledges the positive changes (such as “renewed appreciation for life” and “more personal strength”) that can occur in the aftermath of a crisis (whether a life-threatening illness, combat, or sexual assault).
Consider this: Tedeschi and Calhoun tested this theory by interviewing more than 600 trauma survivors, the New York Times Magazine reports. Surprisingly, the participants reported their experience changed them for the better. Notably, PTG isn’t intended to replace the term PTSD. Instead, PTG can take place “alongside PTSD, after PTSD, or in its absence.”
Criticism: Some academics aren’t convinced that PTG can be objectively defined and accurately measured, the article reports.
© 2014 Omega Institute for Holistic Studies