PTSD: A problematic diagnostic category
Section snippets
What was known
Long before the term PTSD was coined, mental health professionals had seen how frightening events that threaten or produce bodily injuries can evoke a fairly stereotyped distressful psychological state in people. They identified this state as a natural psychological reaction, and in that way similar to the grief reactions produced by personal losses. Their opinions rested on the study of victims of violence and trauma – industrial, natural, political, and military – during the first three
Birth and development of PTSD
PTSD, as we know it today, was born in just such changing circumstances. As the 1960s brought unrest with authority and growing discontent over American military involvement in Vietnam, a group of psychiatrists and Vietnam War veterans combined to propose a new approach to the psychological consequences of exposure to warfare and other forms of trauma.
Most of the psychiatric advocates for the new approach had strong antiwar opinions, especially about this particular conflict. They saw, as
Conclusions
What do we conclude now at the end of this long experience in “Traumatology”? PTSD, as presently diagnosed, described, and treated, has failed to improve on what had been standard teaching. It has redefined and overextended the reach of a long-recognized natural human reaction of fear, anxiety, and conditioned emotional reactions to shocks and traumas. It has been a seedbed for outlandish ideas about mental life. Social and political reasons, more than medical and psychiatric ones, gave it
Acknowledgements
We thank our student Kareem Ghalib M.D. for his help in developing data from Medline on PTSD. We also are conscious of a deep debt of gratitude to Richard J. McNally and Simon Wessely who, on hearing of this manuscript in an earlier form, helped resuscitate it from oblivion and generously offered many important suggestions from their own work and that of others to improve and bring it up to date.
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