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
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
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
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;
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.