Although Veterans Day is firmly in the rear view, the difficult and critical work of offering veterans relief from their trauma remains a daily challenge. Reducing post-traumatic stress among military veterans can lead to a reduction of a host of social ills, but first, we must end its stigma as a “disorder.”
Trauma is an experience as old as humanity. And as long as people have suffered life’s slings and arrows, philosophers, writers and healers alike have sought to understand trauma’s impact.
In the modern era, a number of terms have been used to denote that impact — from “combat hysteria” (Russo-Japanese War of 1904-05), “soldier’s heart” (U.S. Civil War), “shell shock” (World War I), “battle fatigue” (World War II) and “post-Vietnam syndrome,” to the contemporary “post-traumatic stress disorder,” better known as PTSD.
While the name of the condition may have changed over the years, its causes and symptoms have not. Also unchanged are the profound stigmatization around it and the lack of treatment that follows. For some, it is hard to believe that the mere sight of a fellow soldier, dismembered and dying, can cause PTSD symptoms in another.
Equally challenging to achieve, on a societal level, is the recognition that PTSD is the root cause of complex social problems that plague vets: housing instability, addiction, poverty, food insecurity and suicide.
Yet, this is a reality we must face.
Through decades of research, we specialists know that we can successfully restore those who are suffering post-traumatic stress to what I call a “pre-trauma state,” affording them an opportunity to reclaim their mental health and sense of agency. And put them and their loved ones on a path toward wellness.
Clearly, we have ways to help those who are suffering. Yet, many who are afflicted do not have the will to seek treatment, for one deceptively simple reason: stigma. Specifically, the shame associated with post-traumatic stress as a “disorder.”
The numbers tell a grim story:
* Sixteen to 18 U.S. veterans die by suicide each day, government data shows.
* In the U.S., women are twice as likely to develop PTSD than men, according to the Department of Veterans Affairs.
* Approximately 5 in 100 adults in the U.S. deal with PTSD during any given year, the VA has reported.
Further, according to the National Council for Behavioral Health, more than 220 million Americans, or 70% of our population, have suffered at least once in their lives some form of trauma such as rape, domestic abuse, stalking, neglect, incest or bullying, which can carry the threat of sleep deprivation, anxiety, depression, impulsivity and suicide — symptoms of PTSD long thought to afflict only those who saw combat in the military.
Perhaps most troubling is that none of this is inevitable. It’s not that treatments have been tried and have proved unsuccessful. It’s that the stigma has proved too strong, leaving treatments untried.
Early this year, I conducted a survey that demonstrated the potential for changing the term PTSD to PTSI, in which “I,” for “injury,” would replace “D” for “disorder.” The study focused on 1,025 subjects who responded to a survey by telephone. Among the respondents, who were roughly evenly split between female and male, nearly half had previously been diagnosed with PTSD. Over two-thirds of the respondents agreed that a name change to PTSI would reduce the stigma associated with the condition. More than half of the respondents agreed that it would increase their hope of finding a solution to their condition and their likelihood of seeking medical help.
The survey is consistent with the findings that stigma reduction improves treatment outcomes and that the presence of stigma may decrease the likelihood of people seeking support and treatment. The results are also consistent with comments made by now-retired Army Gen. Peter Chiarelli, who at one time was responsible for suicide prevention efforts for the U.S. military.
In an interview with “PBS New Hour,” Chiarelli said the term “disorder” encourages a bias toward the condition and “has the connotation of being something that (was) a pre-existing problem.” The label “makes the person seem weak,” he said.
“It seems clear to me that we should get rid of the ‘D’ if that is in any way inhibiting people from getting the help they need,” Chiarelli said. Classifying it as an “injury” instead of a “disorder” would encourage soldiers, and others, suffering from the condition to seek help.
That’s not all.
Changing the classification from PTSD to PTSI would, I believe, have a global impact societally, as well foster an immediate and positive shift in patient perception of the condition: a benefit for providers, their patients and their families. And it all starts by changing the name we choose to hang on the condition. For what’s in a name, as William Shakespeare asked rhetorically?
In the case of PTSI, everything and more — elimination of a debilitating stigma that represents the biggest barrier to treatment, thereby significantly improving access to care for veterans and many others who are in need, potentially saving countless lives in the process.
Dr. Eugene Lipov is a co-author of the book “The Invisible Machine: The Startling Truth About Trauma and the Scientific Breakthrough That Can Transform Your Life.” He is the chief medical officer of Stella Center and the founder and chief medical adviser of ErasePTSDNow.org.
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