Honor, Stigma…and PTSD

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Army Photo / Spc. Ryan Hallock

I’m an old guy from the Vietnam era, a psychiatrist who studied violence in the 1960s, who treated survivors of trauma in the ’70s and who helped create and nurture the concept of post-traumatic stress disorder through the ’80s.

There are a few dozen of us who are considered the pioneers of the modern era of traumatic-stress studies, and most of us are worried  — deeply worried — on behalf of the current generation of veterans with invisible wounds.

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We thought that by now there would be access to care whenever needed. We thought that by now there would be clear understanding that PTSD is a wound, not a weakness. We thought that a veteran who served honorably and received a compensable medical diagnosis for PTSD due to his or her service on the field of battle, would receive a medal for sacrifice.

But instead of honor, there is stigma. And this stigma must stop.

Stigma is an elusive concept. It means we mark a person or a whole caste of people for exclusion. Stigma may mean we mark ourselves as diminished, degraded and unsuited for inclusion and intimacy. Stigma is insidious, communicated in whispers, in gossip, and in gestures without words.

Why in the world, this enlightened world, would we stigmatize our veterans who come home with PTSD, or traumatic brain injury, or depression?

Perhaps we do it out of ignorance or fear or extrapolation from the few, atypical cases of domestic and criminal violence that grab headlines. When job opportunities are limited due to diagnostic labels, it is reasonable to avoid the label.

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When advancement through the ranks is limited by labels, it is reasonable to reject diagnosis and treatment. So fearing the consequences to livelihood, some suffer in silence and, in a way, add to the climate of stigma.

There are now a growing number of us who have joined a campaign to change this climate of stigma. We cannot wait for the rate of suicide among young veterans to recede of its own accord. We cannot wait for the VA to catch up with its caseload of cases –veterans waiting months for an appointment. We want to change labels, to improve media coverage, to improve awareness, to emulate successful campaigns to reduce stigma, and to honor our veterans who bear invisible wounds.

Here are some activities we commend:

Support the request of former Vice-Chief of Staff of the Army, General (ret.) Peter Chiarelli to change the title PTSD to PTSI – for Injury. Anyone can endorse this campaign right here. But time is limited. It must be done by June 10 to be considered by those with the power to make the change. All the arguments for doing this are on the site.

Visit the Dart Center’s website, particularly if you are a journalist covering this topic. Reporters can do a better job covering trauma, war and PTSD. There are tools of the trade to improve accurate and sensitive reporting of those topics. Bloggers can benefit, too. Telling the true story of PTSD will reduce the stigma of PTSD.

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Attend National PTSD Awareness Day, June 27, on the Senate grounds of the U.S. Capitol. Sponsored by the veterans’ group, Honor For All, this gathering will honor all who have served and sacrificed, including those who took their own lives, struggling with “invisible wounds of war.”

Sign the petition calling on our president to establish a Presidential Advisory Committee to reduce the stigma of PTSD and related invisible injuries, earned in service to our country. This committee could tap leaders in all walks of American life, entertainment figures, professional athletes, architects of the successful campaigns on behalf of breast cancer. If football players can wear pink gloves to support breast cancer awareness, baseball players can swing purple bats on PTSD Awareness Day.

We will not defeat the stigma of PTSD easily. No single idea, petition, campaign or organization can turn public attitude around. Changing PTSD to PTSI is a significant step on the road to honor, away from stigma. The word, injury, is honorable in military culture and accurate in medical parlance. Let’s start there and move forward together.

Frank M. Ochberg, M.D., is the medical adviser of Honor For All, having served in uniform during the Vietnam era. While Associate Director of the National Institute of Mental Health, he helped define PTSD, then edited the first text on its treatment. At Michigan State University, he is clinical professor of psychiatry, formerly adjunct professor of criminal justice, and adjunct professor of journalism.

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