Last part of What Are Post Traumatic Stress Reactions? from the first issue of the PT Gazette.

Here is the last section of of first article in The Post-Traumatic Gazette #1, copyright Patience Mason 1995, 2005,
What are Post Traumatic Stress Reactions?
Denial and discounting are the skills society has developed to deal with trauma, as expressed in “It wasn’t that bad,” and “Aren’t you over that yet?” Statements like these cause secondary wounding in trauma survivors. They reinforce the mistrust trauma evokes in all survivors who no longer can believe that the universe is fair and just. Secondary wounding by the medical community has been a serious problem, from the incest survivor, revealing her rape by her father and being told by the male psychiatrist (trained to believe this), “You know you wanted it,” to the thousands of misdiagnosed, mistreated Vietnam veterans of the seventies,( many of whom are now dead).
It is a problem that still persists.
In DSM IV, published in 1995, the APA has dropped the list of what is traumatic, and the all important sentence which points out that if it would be upsetting to almost anyone and it isn’t to this person then maybe that’s one of the symptoms of PTSD, and added the peculiar phrase that the person has to have felt “fear horror or helplessness” at the time.
Most trauma survivors that I know can’t feel. The diagnostician or therapist is the one who may be able to call up appropriate feelings (eg. grief, rage) about the incident. The survivor shouldn’t have to and probably can’t without a lot of healing. What this really says is that if bad things happen to you and you don’t feel the authorized feelings, they weren’t bad. This is neither logical nor scientific. It will create a class of good survivors who get diagnosis and treatment, and another (bad) class who due to numbing get misdiagnosed and mistreated, just as veterans were after Vietnam. If the APA really needs to list feelings, a more realistic and more diagnostic set would include disbelief, betrayal, feeling nothing, and feeling comfortable. The latter two would signal to any experienced therapist that this person already had PTSD before this latest stressor. Many people have multiple stressors over the course of a lifetime, and have already developed PTSD long before they see a professional. Most trauma survivors never do see a professional.
Adding the words “fear, horror, or helplessness,” to the diagnosis has made it more inclusive in one important sense. It keeps therapists from “pooh-pooh-ing” experiences that terrified individual survivors. The words fear horror or helplessness were added to the diagnosis because trauma turned out to be far more prevalent than the APA expected. (Yes, I am laughing!) The whole diagnosis of PTSD reflects the upper middle class idea that trauma itself is rare. It ain’t!
Rather than redefining trauma as evoking particular emotions, I’d like to see us open our eyes to the invisible effects of trauma.
We must become aware of the costs to survivors, society and families of all forms of numbing and hyperarousal including socially acceptable dysfunctional behavior. By ignoring it, we often simply put off to the next generation the cost and effort of recovering from trauma, and the effects of trauma increase geometrically. This is particularly true because something which might be mildly traumatic to a grownup, particularly one who is numb, is terrifyingly traumatic to a small child. As Beverly James points out, the well known phenomena of the “good” hospitalized child who “misbehaves” when the parent shows up is actually a terrified traumatized child displaying learned helplessness and the freeze response who becomes brave enough to voice his or her terror when the parents are around.
What else can’t we see?
One of the facts we need to face is that PTSD is an epidemic. For every incest survivor, every battered woman, every combat veteran, every holocaust survivor, every survivor of a fire, plane wreck, night club fire, rape, torture, mugging, hurricane, tornado, earthquake, every cop, nurse, firefighter, EMT, for everyone whose pain is not listened to and felt and accepted and healed, the effects of the trauma spread geometrically. Drug abuse, AIDS, heart disease, obesity, all related to the epidemic of PTSD through the compulsive behaviors people use to numb their pain and the inability to take care of one’s self which numbing causes.
If 17% of the teenagers in Detroit had tuberculosis, it would be a national emergency. Because they have PTSD, and PTSD is not acknowledged nor well understood, no one is talking about it. But we can.
New notes: Because it is so distressing for many professionals to know about trauma, there is a historical record of a period of acknowledgement followed by a period of denial and forgetting. Right now there are conflicting currents. The American Psychiatric Association has transformed the description of traumatic stressors in DSM III into a numbing ritual in which big Latin-rooted words alternate with the word “or” until the person reading it is practically asleep. This makes it hard to comprehend when someone has been traumatized
There are even academics who are once again doubting the diagnosis, saying it is overused. This is quite popular with those who don’t like paying the entire costs of war.
In addition soldiers resent the term PTSD. It feels like a stigma, and is treated as one in some commands. In Canada they use the term Occupational Stress Injury and include anxiety and depression as well as PTSD. Here some military psychiatrists are using CSI, Combat Stress Injury, which service members find less stigmatizing. I suggest Stress Injury with subtypes: Occupational for first responders, peacekeepers, etc; Combat for soldiers; Crime for survivors of rape, incest, interpersonal violence; Disaster; Betrayal; Neglect, etc.
Service members, unlike previous wars, are being sent back into harm’s way on medications with PTSD. This illustrates the ethical problems inherent in military psychiatry, which focuses on getting people back into action. Is it safe? Probably not. People with PTSD can be hypervigilant and overreact, instead of being vigilant and react with appropriate force.
Will it make them worse to go back with PTSD? Yes it will. But that is their job, and many of them want to go.