Is the PTSD Diagnosis Sending the Wrong Message?

Helping Veterans Move Beyond Victimization

Roy Clymer

At eight o'clock on Tuesday morning, I walk into a nondescript room at Walter Reed Army Medical Center to greet seven soldiers and marines who've been back from Iraq or Afghanistan for a year. Sprawled around a large, coffee-stained table, looking wary, the vets are here because they, or someone else, said they have post-traumatic stress disorder (PTSD).

This is the first meeting of an exposure therapy group I'll be facilitating, and I'm anxious because if the treatment goes well, it'll be painful for them, and everyone prefers to avoid pain. These men and women have been treated with medications or intermittent counseling to help them deal with the emotions and conflicts they fear, but they remain symptomatic.

I start the group by explaining how exposure therapy came to be the treatment of choice for people suffering the ill effects of horrible events. I describe it as a process by which people can begin to contact their feelings about the devastating events they've experienced, and how embracing those experiences eventually enables them to move on with their lives. When I finish, John, a wiry guy with a blond crew cut, thumps his fist on the table. "Move on?!" he asks incredulously. "What's that about? I will never forget! I'm a living shrine to all my buddies who died in Iraq. They can't be forgotten!"

Before I can respond, he launches into his story. Last year, just outside Baghdad, an Improvised Explosive Device (IED) shattered the truck in front of him. He raced to pull the bloodied soldiers from the vehicle. One of them, his best friend, Larry, was barely alive. John rendered first aid, but Larry died on the medevac flight out.

Our Ambivalence

Imagine now that these events happened to you or someone you care about deeply. Do you notice any attempt to avoid or move quickly away from the pain, fear, and horror these stories evoke in you? Do you want to distance yourself from the reality of what happened, to diminish or mute the feelings getting stirred? Are you asking yourself how you might deal with such horrors?

Ambivalence is at the core of our response to such stories. When we hear of a horrific event, we may try to understand it by imagining what it would be like for us to have that experience. We'd like to think that we could surmount such catastrophes, but if we're at all aware of our own vulnerabilities and limitations, we probably doubt that we could, yet we're aware of our internal judgments and how we tend to hold others responsible for their ability to manage life's challenges.

The Trouble with Trauma

What does the veteran hear when he's told that he has PTSD? Disorder, as defined by the Diagnostic and Statistical Manual, means an abnormal condition that impairs function. Trauma is a medical term used to describe the physical damage caused by energy impacting tissue (a bullet shot into a soldier's flesh, for example). It implies a serious, even grave injury—a deep chest wound, not a paper cut. Stress is defined as a psychophysiological response to a perceived threat, experienced internally and subjectively.

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So, we have in PTSD the badly fitting juncture of two distinct concepts: a physical wound (which actually doesn't exist) and a varied and variable set of psychological and behavioral symptoms. The active, thinking, feeling person is removed from the equation, becoming a passive, damaged organism.

Thus, at some arbitrary point, stress becomes trauma, a response becomes damage, the temporary becomes enduring, and the subjective ("I feel stressed") becomes objective ("You have PTSD"). Then the power to define what's happened shifts from the person to the mental health provider, and the person's self-perception shifts from responsible agent to damaged victim of terrible circumstances who's in need of help, now and probably in the future.

What's in a Diagnosis?

My main objection to the way we understand and use PTSD is that it tempts all of us—providers, society, and veterans—to view the veteran as a victim. It provides the false balm to the soldier that he's this way because of what happened to him. He's offered a disabling but clearcut condition, which, with the doc's help, he can try to overcome. Imagine the strength it takes to refuse such an offer!

The PTSD diagnosis provides what appears to be an easier way out of pain and conflict than struggling with the existential, often terrible, realities of life. The fundamental, universal human dilemma—how to cope with overwhelming feelings, come to terms with inherently opposing realities, find meaning in meaningless chaos—is turned into a "psychiatric disorder" that can be "treated." Like the rest of us when we have an "illness," the veteran hopes that there's a pill that'll fix him and send him on his way. But of course there isn't. Nor is any therapeutic approach that's geared just to alleviating his symptoms likely to work. True healing requires knowing and accepting all our experience.

A Different Approach

When soldiers return—bloodied, shaken, defended, cut off—they feel that they don't fit in with those who haven't done what they've done. And they don't. They're at huge risk for alienation, isolation, bitterness, and cynicism. We owe it to them to give them a form of help that fully acknowledges their experience of unimaginable terror and horror. More than this, however, we must convey to them that they're affected, but not damaged, and they're capable of responsible, rather than simply reflexive, behavior. In doing so, we may help reignite what's strongest and most capable in them. They survived war: they can do anything.


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Roy Clymer, PhD, attended the United States Naval Academy, followed by four years of active duty, including a tour in Vietnam on river patrol boats. He's been a researcher and a clinician in both the public and private sectors, and is presently employed as a contractor. He directed a program at the Walter Reed Army Medical Center that treated veterans returning from combat deployments.

This blog is excerpted from "The Puzzle of PTSD" by Roy Clymer. The full version is available in the November/December 2010 issue, The Wounds of War: Returning Vets are Challenging Us to Rethink Our Approaches to PTSD.

Photo © Katarzyna Bialasiewicz/iStock

Topic: Trauma | Anxiety/Depression

Tags: depression | DSM | post traumatic stress disorder | psychotherapy | PTSD | therapist | therapy | traumatic | veterans | stress | networker | war | Iraq | Afghanistan | disorder | Walter Reed | soldiers | battle

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6 Comments

Wednesday, May 18, 2016 8:18:18 AM | posted by Bart Sherwood
TWENTY-TWO suicides daily since March 2013, and the VA has done virtually nothing to facilitate a decrease. The stigma that VA and DoD officials have placed on the 'PTSD' label is nothing less than criminal malpractice and slander. Maybe if PTSD was reclassified as an Occupational Hazard, renaming it Military Induced Anxiety Depression Syndrome (MIADS) and treating it thusly.... Maybe John's response "Move ON??" would be better served with actually healing instead of the treatment with poly-pharmaceuticals and sometimes senseless talk. The problem is that the VA is hung up on the Agent Orange Issues and response of delay and deny treatment and sufficient numbers will die over a 20 to 25 year span that will allow treatment of the survivors!!! God Bless President Reagan and Budget Director Stockman!!!

Sunday, May 15, 2016 11:21:29 AM | posted by Pam
I believe we should switch to the Canadian term Post-Traumatic Stress Syndrome, which destigmatizes the condition and sounds a lot less judgmental than "Disorder".

Saturday, May 14, 2016 1:26:31 PM | posted by David
Why not frame all mental health diagnoses the way Roy Clymer frames PTSD? From a family systems viewpoint, I think all mental health "disorders" are responses/reactions to either acute or chronic anxiety. Responding to anxiety is natural, not "ill."

Wednesday, October 7, 2015 3:47:36 PM | posted by Thomas Whittingslow
May we talk?

I am writing a non-fiction book titled: RE-ENTRY: Transforming Warriors Into Scholars and Community Leaders. It tells the personal inspirational stories of veterans who have experienced PTSD, traumatic brain injury, and other disabling traumas from military experience to become successful students and assets to their community. Five interviews have been completed. After reading your response to Moving Beyond the PTSD Label, I would like you to consider being a candidate for an interview.

If you are interested I will send you the introduction plus several sample chapters.
I hope you will consider this opportunity to inspire other veterans.

Sunday, September 20, 2015 1:44:42 AM | posted by Beth
I appreciate your passion, Roy, but I have had a differnet experience clinically. Thank you, sincerely, for your work ongoing with veterans. Your compassion and confidence in a person's resilience and ability to heal is wonderful and inspiring. I just have not had the experience that collaboratively considering a diagnosis of PTSD dehumanizes people who have experienced trauma. In my experience, it can give them a non-judgemental place to land -emotionally-and to begin to heal, once they have a relationship in which to share how stressed, anxious, or confused they feel. It's not an end point; it's a beginning. It sounds like you're offering an important place to heal in your groups, too. Thank you.

Saturday, September 19, 2015 1:48:38 PM | posted by Gloria
An excellent article! I'm a veteran who has had experience with P.T.S.D. I did not become involved in the V.A. medical system escaped the labeling process. I am a psychotherapist and as part of the requirements of my program,engaged in therapy. I faced many painful issues and was able to move beyond them and establish a meaningful life in which I am able to help others overcome very traumatic situations successfully.
I have had personal experience in moving beyond the label and living life on my terms rather than being defined by a diagnostic process.