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New name for PTSD could mean less stigma

The Bread Guy

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The president of the American Psychiatric Association says he is "very open" to a request from the Army to come up with an alternative name for post-traumatic stress disorder so that troops returning from combat will feel less stigmatized and more encouraged to seek treatment.

Dr. John Oldham, who serves as senior vice president and chief of staff at the Houston-based Menninger Clinic, said he is looking into the possibility of updating the association's diagnostic manual with a new subcategory for PTSD. The subcategory could be "combat post-traumatic stress injury," or a similar term, he said.

"It would link it clearly to the impact and the injury of the combat situation and the deployment experience, rather than what people somewhat inaccurately but often assume, which is that you got it because you weren't strong enough," Oldham said.

The potential change was prompted by a request from Gen. Peter Chiarelli, the Army's vice chief of staff, who wrote to Oldham last year, suggesting APA drop the world "disorder" from PTSD.

"Calling it a disorder contributes to the stigma and makes it so some folks - not all, but some folks - don't get the help they need," Chiarelli said.

The general doesn't like to use the word disorder. "It's not a dirty word, but I think it's misused here," he said. "I don't think that the post-traumatic stress that soldiers experience is a disorder. It's not something that happens just to weak people or people that are somehow inclined to be affected by horrible things that they see or are required to do. I think it causes an actual injury to the brain and how the brain works." ....
Houston Chronicle, 15 Jan 12

Hat tip to the Bouhammer Military Blog for highlighting this article.
 

OldSolduer

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I think that's a good idea.

Flashbacks aren't always negative ones. How many times have we been "flashbacked" very briefly to someplace or something that brings us joy?

Post Traumatic Stress Spectrum might be a more agreeable term?
 

The Bread Guy

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Jim Seggie said:
I think that's a good idea.

Flashbacks aren't always negative ones. How many times have we been "flashbacked" very briefly to someplace or something that brings us joy?

Post Traumatic Stress Spectrum might be a more agreeable term?
Isn't the term "Operational Stress Injury" (OSI) used more often here in Canada?  Or are we talking a different usage?
 

the 48th regulator

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milnews.ca said:
Isn't the term "Operational Stress Injury" (OSI) used more often here in Canada?  Or are we talking a different usage?

Correct, OSI is used here, however it is not a medical term.  It is an umbrella description that covers all mental injuries associated to duty.  i.e Depression,  Anxiety, and other Psychological conditions.  PTSD is still the acronym we use for Post Traumatic Stress Disorder.

dileas

tess


 

GAP

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and PTSD can include  "Depression,  Anxiety, and other Psychological conditions"
 

the 48th regulator

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GAP said:
and PTSD can include  "Depression,  Anxiety, and other Psychological conditions"

However, PTSD is a separate injury/Disorder, that may cause symptoms similar to other disorder.  However, there are specific criteria that separates as it's own disorder.

A flat tire is caused when air is released from the inner tube.  It can be caused by a puncture.  IT is still a flat tire, however a pucture can be from glass, nails, screws, knife, ice pick.......

dileas

tess

 

Rifleman62

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On FOX News today. Below is Washington Post article.

http://www.tampabay.com/incoming/new-name-for-ptsd-could-mean-less-stigma/1228758

New name for PTSD could mean less stigma

Washington Post -  May 7, 2012

It has been called shell shock, battle fatigue, soldier's heart and, most recently, post traumatic stress disorder, or PTSD.

Now, military officers and psychiatrists are embroiled in a heated debate over whether to change the name of a condition as old as combat.

The potential new moniker: post traumatic stress injury.

Military officers and some psychiatrists say dropping the word "disorder" in favor of "injury" will reduce the stigma that stops troops from seeking treatment. "No 19-year-old kid wants to be told he's got a disorder," said Gen. Peter Chiarelli, who until his retirement in February led the Army's effort to reduce its record suicide rate.

Today, a working group of a dozen psychiatrists will hold a public hearing in Philadelphia to debate the name change. The issue is coming to a head because the American Psychiatric Association is updating its bible of mental illnesses, the Diagnostic and Statistical Manual of Mental Disorders, for the first time since 2000.

The relatively straightforward request, which originated with the Army, has raised new questions over the causes of PTSD, the best way to treat the condition and the barriers that prevent troops from getting help. The change also could have major financial implications for health insurers and federal disability claims.

Chiarelli took on the problems of PTSD and suicide after two tours in Iraq and pressed harder than any other officer to change the way service members view mental-health problems. His efforts, however, have not resulted in a reduction in suicides.

PTSD refers to the intense and potentially crippling symptoms that some people experience after a traumatic event such as combat, a car accident or rape. To Chiarelli and the psychiatrists pressing for a change, the word "injury" suggests that people can heal with treatment. A disorder, meanwhile, implies that something is permanently wrong.

Chiarelli was the first to drop the word "disorder," referring to the condition as PTS. The name was adopted by officials at the top levels of the Pentagon, including Defense Secretary Leon Panetta. But PTS never caught on with the medical community because of concerns that insurers and government bureaucrats would not be willing to pay for a condition that wasn't explicitly labeled a disease, disorder or injury.

Some psychiatrists suggested Post Traumatic Stress Injury as an alternative, and Chiarelli heartily endorsed the idea.

The question for the working group of doctors debating the change is whether the nightmares, mood swings and flashbacks normally associated with PTSD are best described as an injury.

Disorder or injury

Those in favor of the new name maintain that PTSD is the only mental illness that must be caused by an outside force.

"There is a certain kind of shattering experience that changes the way our memory system works," said Frank Ochberg, a professor of psychiatry at Michigan State University.

The intensity of the trauma, whether it is a rape, car crash or horrifying combat, is so overwhelming that it alters the physiology of the brain. In this sense, PTSD is more like a bullet wound or a broken leg than a typical mental disorder or disease. "One could have a clean bill of health prior to the trauma, and then afterward, there was a profound difference," wrote Ochberg in a letter backing Chiarelli's request for a change.

Psychiatrists who oppose the change say PTSD has more in common with bipolar or depressive disorder than a bullet wound.

"The concept of injury usually implies a discrete time period. At some point, the bleeding will stop. Sometimes the wound heals quickly, sometimes not," said Matthew Friedman, executive director of the Department of Veterans Affairs National Center for PTSD. A disorder can stretch on for decades.

Although everyone is equally susceptible to a gunshot wound, not everyone exposed to trauma suffers from PTSD. Genetics, military training and even the cohesion in a soldier's platoon all play a role in determining whether a combat experience results in PTSD or simply a bad memory, experts said.

"The word 'disorder' reflects the fact that some people are more vulnerable than others," said John Oldham, president of the American Psychiatric Association.

Treatment for the malady often includes remembering the traumatic event under controlled conditions until it loses its power.

PTSD made its first appearance in the diagnostic manual's third edition, which was published in 1980. The doctors who lobbied for its inclusion viewed it as a measure that would finally legitimize the pain and suffering of Vietnam War veterans.

Prior to the creation of the PTSD diagnosis, Vietnam War-era hawks saw troops suffering from such symptoms as weaker than their World War II-era colleagues. "The view was that they should just suffer in silence," said Charles Figley, director of Tulane University's Traumatology Institute. The antiwar doves often portrayed Vietnam War veterans as crazy, deranged and dangerous.

"PTSD was a validation that what the Vietnam veterans were reporting was true," he said.

The name-change debate is also being influenced by bureaucratic politics. In 2008, the military considered awarding the Purple Heart to troops suffering from PTSD, but ultimately decided that brain science had not advanced far enough to prove that people were suffering from the condition.

A change to "injury" would make it easier to revise the award criteria, advocates of the name change say.
 

medicineman

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It's a mental illness...pretty hard to take the stigma out of that.

But what do I know?

MM
 
J

jollyjacktar

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If it helps that's a good thing.  I got fishy looks from some quarters after I went for help, if this kills some of the fishy smell I'm all for it.  At any rate, things are better than they were years ago thank fuck.
 

mariomike

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Rifleman62 said:
Search function is not working for me. Not one hit for: PTSD.

Here are some:
http://www.google.com/cse?cx=001303416948774225061%3Aqhcx9pz3dku&ie=UTF-8&q=PTSD&sa=Search&siteurl=www.google.com%2Fcse%2Fhome%3Fcx%3D001303416948774225061%3Aqhcx9pz3dku&ref=#gsc.tab=0&gsc.q=PTSD&gsc.page=1
 

Spooks

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My  :2c: and first-hand opinion

PTSD, PTSI, anxiety disorder, or wherever you call it....in my belief, it's something you do not recover from. From my experience it's something you just learn to cope with or handle better. After my injury, I had issues with crowded places, noises of crowds and other things that you could link to that. Even though I was not diagnosed with PTSD, VAC believes I have it. The problem is that PTSD and TBI (Traumatic Brain Injury) are very very similar in symptoms and PTSD is just a different kind of brain injury. I used to have all those problems yes, and I received help. Problem is, I still have them. The difference now is that I have the tools to better deal with symptoms when they come on. I either do the 'there's nothing bad about this situation' techniques or I simply remove myself from the situation (ie. West Ed Mall is crazy as hell during Xmas and I can only stand shopping there for 3-4hrs max in a stint).

There are other aspects of PTSD that I do not manifest which others do, and I do not believe they will ever 'recover' from them. I think their best hope is learning how to deal or cope with symtoms. Calling it an 'injury' vs a 'disorder' will not give it less of a stigma and convince people to come forward. People will forever be hesitant to get help b/c you wake up one day and your mind doesn't function how your 'normal' is. That is one of the most terrifying things that can happen to someone in their life - realising that you don't know yourself anymore. When you don't know how to call it, you aren't gonna go get help b/c you don't know who can help.

What will take down the stigma is have better avenues to get help and make it more available. What will also help is to have fewer people go around calling those with PTSD 'weak' or a 'malingerer'. A problem to changing that is that you may likely remove a unique and motivating aspect of the military. If I am unfit, I expect to be called a 'fata**', if I suck at drills, then I will be called a 'gluebag'. The military uses this (immature) name calling as an effective tool to motivate people. 'I don't wanna be a gluebag so I will get my drills in order'. With PTSD, that naturally and unfortunately carries over. You can't see the gleaming white bone from a broken arm. You can't see the blisters from bad boots. You are going off of their word by faith alone. Many people use this 'hazy classification' to their advantage and confabulate symptoms. This, in turn, makes other think that all people that say they have PTSD are just faking it. Your cure for the PTSD problem isn't with calling it something different, but differentiating between those who do suffer from it and those making it up. Since that is not possible, it won't be cured.

To be 100% honest, I am offended that some General or high-up person that wants to make their mark in history thinks that 'calling it an injury implies that it can be cured'.
[/rant/
 
J

jollyjacktar

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I agree with most of what you say GoJ.  It's true, I'm not cured.  Better than I was, and I do know where to go to get the lid screwed down again when I feel it's time.  I have found as time stretches from my last visit to the OSI folks that some of the demons have been mewling in the dungeons again.  I suspect that I'll be seeing those folks again in the not too far distant future.

If Romeo Dallaire wants to try and give it another name, I'm not personally offended.  He is a fellow sufferer not some outsider, and his intentions are honourable in my opinion.  If it helps in the grand scheme of things, I'm all for it.  And seeing as he brought the need to the fore with the CF and made change happen to where there is progress today that was not there 20 years ago, more power to him.
 

Journeyman

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And here I thought OSI -- "Operational Stress Injury" -- was the current term.

Man, I hate pronouncements around PER season.
 

Gronk

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I was under the impression that here in Canada, we have been using the term "Operational Stress Injury" for years. Is this not basically the same idea?
 

Wookilar

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The problem with OSI is the "operational" part.

That gives it a connotation, rightly or wrongly, that a "stress injury" can only happen on operations, which most people, even inside the military, see as meaning overseas. Even though the Swiss Air crash was an "operation" (EVERYTHING we do is an operation), most do not think of it that way.

As for a name change, it's small, but this is the way I have been thinking about for a while now. And how I have been explaining it to others.

It is an injury, no different than the ankle I snapped after that argument I had with a rappel tower. If you watch me on a BFT, I have a swagger  ;D that gets more pronounced the farther we go. Makes sense. With the PTSI, if you watch me in certain situations, you will see me "limp" in one way or another.

It may not seem like much, but language is a powerful thing. It might just be the thing to continue the reduction of stigmatization inside the CF.

Wook
 

medicineman

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jollyjacktar said:
If it helps that's a good thing.  I got fishy looks from some quarters after I went for help, if this kills some of the fishy smell I'm all for it.  At any rate, things are better than they were years ago thank frig.

Everyone gets those fishy looks unfortunately...and as GoJ suggests, you likely don't really get over alot of that stuff, but learn to cope with it or to change your thought patterns such that you're more in control of it than it of you, which is by far the most imprortant thing when dealing with any kind of depression, anxiety, etc.  But changing the name isn't going to change how people think about anything like that - mental illness is a bogeyman alot of folks can't get a grip on simply because they can't see it, feel it, touch it, etc, so how can it exist or worse - what if they themselves get it and "lose their marbles too"?  Most people, once over the initial shock, have no worries about losing a limb, an eye, etc...losing our minds however, is one our greatest fears.  There's the rub, IMHO.    :2c:

And as I post this, Wookilar pointed out something else - there are people outside the military that suffer from this problem as well.  The Trauma Unit a t Van General where I did some of my PA training always had a psychiatrist see and assess ALL patients admitted to the unit - some had TBI's for certain, but others had emotional issues stemming from survivor guilt, helplessness from being assaulted, etc - all part of the PTSD spectrum of stuff that can cause or perpetuate it.  This isn't something that's limited to soldiers or emergency service workers, though there is a high predomminance due to recurrent exposures and cultures of not talking things out with folks.

MM
 

the 48th regulator

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Operational Stress Injury is not a medical term, but an umbrella term that covers many types of Mental injuries.  (Depression, Anxiety, PTSD,a nd other Minor Psychological condidtions)

Operational, is anytime you are performing your military duties, regardless of you Geographic location.

The reason injury is used, people can visualize an injury, as opposed to an illness i.e a cold, or cancer.  Basically, it encourages people to treat the injury at an earlier stage.


dileas

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Journeyman

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the 48th regulator said:
Operational Stress Injury is not a medical term, but an umbrella term that covers many types of Mental injuries.
So would a generalized term like OSI not be preferable? It still includes "injury," so it should be good to go.

How much research effort/SMEs' time is being frittered away changing "happy" to "glad" so that someone can say, "Oh, that term is so last February"?
 

medicineman

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Fact of the matter is, no matter what you want to call it, the DSM IV-TR diagnosis is not OSI...it's used in the CF to encompass all matter of issues that can arise from being exposed to the shyte and abuse service personnel get exposed to on operations to differentiate from non-operational mental health issues.  This is an important differentiation for the folks at VAC that have to dole out financial resources to help the people concerned and determine what the benefit(s) should be.  It's also an attempt, as tess noted, to "normalize" the conditions as we would to any MEDICAL or SURGICAL problem a member may develop.  To me, a patient is a patient is a patient, but to some supervisor, someone that comes back with a chit but no cast, sling, splint, stitches, etc is a malingerer because there is no visibile sign of anything wrong with them (unless they snap right there and then).

MM

Edited for spelling
 
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