What’s In a Name?

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I want to add to the debate on the hot issue at the American Psychiatric Association this week. Retired Army general and vice chief of staff Peter Chiarelli made a strong case for re-naming post-traumatic stress disorder, or PTSD. Chiarelli advocates calling it post-traumatic stress injury. The Canadians use the term “operational stress injury” or OSI. The U.S. Marines have advocated the injury concept for a while.

Before, I was not in favor of the name change. Psychological reactions to war have been called by many names: shell shock; not yet diagnosed, nervous; battle fatigue; combat stress reaction; and of course PTSD. Does the name really make a difference?

I have said, and still believe, that the most important issue is how Soldiers and other service members are treated by the military and by society. That is the most important component to stigma.

But I am changing my opinion on nomenclature. If indeed, Soldiers are more likely to seek medical care if the term used is “injury”, rather than “disorder”, it is worth a try.

Basically Soldiers hate to go see therapist who ask them about all their problems, and imply that the problem is with them. “I would rather kill myself than go to a shrink” is a not-uncommon statement.  Although there are evidence-based therapies, such as cognitive behavioral therapy, if the Soldiers will not go, how effective are they?

And if indeed, 20 to 30% of Soldiers are developing post-traumatic stress symptoms, is it really a disorder, or simply a common reaction to the horrendous stresses of combat?

There were a number of other relevant sessions at the APA, which discussed more acceptable routes to care, including so called complete and alternative treatment (CAM) or integrated care. They include virtual reality, acupuncture, yoga, and therapy dogs.

Now there is another critically important aspect, which is the implication for the disability system. Currently Soldiers with PTSD receive 50% disability. There are concerns about whether changing the label would affect the disability rating. We would have to work through that, to ensure that there are not significant unintended consequences.

Nevertheless if we could combine a more acceptable label with treatments that Soldiers would go to, it would be huge benefit to all.