Around about 20 years ago, President Bush number 2 and some people at the Pentagon who were probably not doctors got together and decided that for military purposes they were going to stop using the D for Disorder of Post Traumatic Stress Disorder. The thought was that if they called PTSD just Post Traumatic Stress and normalized it by dropping the Disorder, it would reduce the stigma of getting help and allow combat veterans to feel more “normal” about what they were experiencing as they came back from deployments.
Although the intention is legit, reducing the stigma of PTSD is important; changing Post Traumatic Stress Disorder to Post Traumatic Stress is not only clinically inaccurate, but it does a huge disservice to those suffering with the disorder and their impacted family members. Saying it’s just Post Traumatic Stress suggests that it can be addressed in the military way: Drink Water, Take Motrin, Put Dirt On It, Walk It Off. It’s just PTS, no big deal, get over it and if you have PTSD you must be a bitch.
Post Traumatic Stress:
- A car accident and then the next couple of times you drive past the site of the accident you get a little shaky. Maybe you have some difficulty sleeping for a few nights after the event.
- Someone steals your atm card while you are trying to withdraw money; you become super cautious and look over your shoulder repeatedly when using an atm machine for some time afterward.
Post Traumatic Stress Disorder:
- Your life/wellbeing or that of someone close to you was significantly at risk
- You can’t bare to think about what happened because of the amount of distress it causes to remember
- You lose sleep, constantly haunted in your dreams by what happened/could have happened.
- The feelings of vulnerably connected to the event become unbearable and instead manifest as anger and/or depression
- Your body is constantly on alert looking for threats.
- Any additional stress can send you over the edge so that you are unable to function the way you used to.
Instead of leaving off the D, I’d rather we leave off the PT. At it’s most basic level, PTSD can be understood as a Stress Disorder. The PT refers to how the stress disorder developed and may indicate the triggers but at the end of the day, people with PTSD have a hard time managing all types off stress. The ability to regulate stress, calm down, and identify the cause of the stress is broken. It’s exactly this stress response that needs to be validated and treated.
If someone comes in for treatment with a lot of symptoms, the first questions need to be about what is happing in their lives today that might be causing a sense of fear or dread. That stress in the current moment triggers the client to go back in emotional time to the situation first or most significantly associated with that feeling. There is always a trigger. The trigger might be an unpaid bill, an upset spouse, a sick kid, a stomachache, or a rough commute. Cortisol gets released into the blood stream and the stress disorder, instead of saying “yellow alert,” starts screaming “red alert, life and wellbeing are significantly at risk.”
Very simplified, treating a stress disorder means helping people recognize the current stressor or perceived threat, reality checking the severity of the threat, validating where and when the “red alert” level response was learned (the Trauma), and then addressing the current situation. Treating a stress disorder means relearning how to regulate emotions and tolerate the inherent vulnerability of being human. It means finding new strategies to keep baseline stress down: low stress exercise, mediation, healthy eating, and supportive relationships.
The best way to address the stigma of having PTSD is through relationships. Maybe the first relationship that beats back the stigma is with a therapist who understands the pattern and can help symptoms feel more predictable and less out of control. Maybe the supportive relationships are with peers who have been through something similar. As we saw with the #metoo movement, when a few people come forward, it gives many others the courage to do so as well and eventually there will be no more stigma.